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Dehlendorf C, Perry JC, Borrero S, Callegari L, Fuentes L, Perritt J. Meeting people's pregnancy prevention needs: Let's not force people to state an "Intention". Contraception 2024; 135:110400. [PMID: 38369272 DOI: 10.1016/j.contraception.2024.110400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
Pregnancy intention screening does not identify need for pregnancy prevention and ignores the nuances of lived experiences while reinforcing white middle-class normative expectations. Asking about desire for contraception is a patient-centered approach to meeting people's needs.
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Affiliation(s)
- Christine Dehlendorf
- Person-Centered Reproductive Health Program, UCSF Departments of Family and Community Medicine, San Francisco, CA, United States.
| | | | - Sonya Borrero
- Center for Innovative Research on Gender Health Equity (CONVERGE), Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lisa Callegari
- Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, WA, USA
| | - Liza Fuentes
- Health Equity Accelerator, Boston Medical Center, Boston, MA, USA
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Gonzalez SC, Melvin P, Landrigan CP, Allende-Richter SH. Contraceptive Method Usage Pattern and Percentage of New Pregnancies Among Adolescent and Young Adult Family Planning Patients: A Mixed-Methods Retrospective Study. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00234-1. [PMID: 38906215 DOI: 10.1016/j.jpag.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/12/2024] [Accepted: 06/16/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVES Despite increased access to contraceptive methods (CM), the United States still has the highest rate of adolescent pregnancy among industrialized nations, and adolescents from historically marginalized groups are disproportionately affected. In this study, we sought to (1) understand if differences in CM usage were associated with differential percentages of new pregnancies among adolescents and young adult patients attending a family planning (FP) clinic at an urban community practice and (2) identify areas of improvement in our FP counseling. METHODS Mixed-methods study design consisting of (1) a 12-month retrospective chart review and (2) a self-answered cross-sectional survey of FP patients. Chi-square, Fisher's exact tests, and risk ratio were performed to analyze the percentage of new pregnancies according to CM usage. RESULTS The percentage of new pregnancies was 11 among our FP patients (N = 555) during this study period. As anticipated, pregnancy was associated with no CM use, CM discontinuation, and, interestingly, multiple CM changes (P < .001). The probability of no-pregnancy significantly decreased among patients on no method, who discontinued their CM or made multiple CM changes compared to those with continuous CM use. There was no association between the percentage of new pregnancies and any particular CM type. CONCLUSION Despite adequate access to FP patient services and high patient satisfaction levels, our findings indicate a need to adopt a more patient-centered approach in our FP counseling that addresses patient's reproductive life plans, preferences, and method side effects to increase CM uptake and satisfaction and decrease frequency of CM changes which is associated with increased risk of mistimed pregnancy during method switching.
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Affiliation(s)
| | - Patrice Melvin
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Christopher P Landrigan
- Harvard Medical School, Boston, Massachusetts; Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Sophie H Allende-Richter
- Harvard Medical School, Boston, Massachusetts; Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
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Espinosa M, Butler SA, Mengelkoch S, Prieto LJ, Russell E, Ramshaw C, Rose-Reneau Z, Remondino M, Nahavandi S, Hill SE. The Impact of a Digital Contraceptive Decision Aid on User Outcomes: Results of an Experimental, Clinical Trial. Ann Behav Med 2024; 58:463-473. [PMID: 38828482 DOI: 10.1093/abm/kaae024] [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: 06/05/2024] Open
Abstract
BACKGROUND Nearly 40% of unplanned pregnancies in the USA are the result of inconsistent or incorrect contraceptive use. Finding ways to increase women's comfort and satisfaction with contraceptive use is therefore critical to public health. One promising pathway for improving patient outcomes is through the use of digital decision aids that assist women and their physicians in choosing a contraceptive option that women are comfortable with. Testing the ability of these aids to improve patient outcomes is therefore a necessary first step toward incorporating this technology into traditional physician appointments. PURPOSE To evaluate the effectiveness of a novel contraceptive decision aid at minimizing decisional conflict and increasing comfort with contraception among adult women. METHODS In total, 310 adult women were assigned to use either the Tuune contraceptive decision aid or a control aid modeled after a leading online contraceptive prescriber's patient intake form. Participants then completed self-report measures of decisional conflict, contraceptive expectations, satisfaction, and contraceptive use intentions. Individual between-subjects analysis of variance (ANOVA) models were used to examine these outcomes. RESULTS Women using the Tuune decision aid (vs. those using the control aid) reported lower decisional conflict, more positive contraceptive expectations, greater satisfaction with the decision aid and recommendation, and more positive contraceptive use intentions. CONCLUSIONS Use of Tuune improved each of the predicted patient outcomes relative to a control decision aid. Online decision aids, particularly when used alongside physician consultations, may be an effective tool for increasing comfort with contraceptive use. CLINICAL TRIALS REGISTRATION # NCT05177783, ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/NCT05177783.
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Affiliation(s)
- Matthew Espinosa
- Department of Psychology, Texas Christian University, Fort Worth, Texas, USA
| | | | - Summer Mengelkoch
- Department of Psychology, Texas Christian University, Fort Worth, Texas, USA
| | | | | | | | - Zak Rose-Reneau
- Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma, USA
| | - Molly Remondino
- Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma, USA
| | | | - Sarah E Hill
- Department of Psychology, Texas Christian University, Fort Worth, Texas, USA
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Palma S, Ayres-de-Campos D, Antunes M, São-João R, Presado MH. Contraceptive Counseling: Construction and Validation of Instrument-"5C Contraceptive Counseling". Healthcare (Basel) 2024; 12:1088. [PMID: 38891163 PMCID: PMC11171611 DOI: 10.3390/healthcare12111088] [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: 04/22/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION Contraceptive illiteracy leads to non-adherence, discontinuation, and dissatisfaction with the method. Person-centered contraceptive counseling is based on quality care on a communicative basis that promotes shared decision-making, leading to a choice adapted to the woman's needs, lifestyle, and health condition. We intend to build and validate an instrument that serves as a guide for quality contraceptive counseling, facilitating decision-making about contraceptive methods. METHODS We used the Delphi method in a total of two rounds. The content was validated through a panel of eighteen experts with experience in teaching, research in contraceptive counseling, and obstetric nursing. To assess the consensus and stability of the responses, two questionnaires were administered and the Content Validity Index and Content Validity Ratio were calculated. RESULTS The initial version of the guide, consisting of six indicators and thirty-five items, was submitted to the panel of experts to obtain consensus and stability from respondents (first round). The results showed a response rate of 66.0%; thirty-four indicators reached consensus and one did not reach consensus. Suggestions for modifying the indicator were received by the experts and incorporated in the next round. In the second round, the response rate increased to 78.0%. Two indicators were resubmitted, of which one was accepted. This resulted in the final version of the instrument, with six points and thirty-five items. DISCUSSION The guide proved to be a valid tool for nurse-midwives to provide quality contraceptive advice to women, allowing them to make autonomous and informed choices regarding their sexual and reproductive health.
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Affiliation(s)
- Sara Palma
- Nursing School of Santarém, Polytechnic Institute of Santarém, 2005-075 Santarém, Portugal
- Nursing Research, Innovation and Development Center of Lisbon (CIDNUR), 1600-096 Lisbon, Portugal (M.H.P.)
| | | | - Mónica Antunes
- Garcia de Orta Hospital, ULS Almada/Seixal, 2805-267 Almada, Portugal
- Nursing Research Platform Lisbon of Health Research Center (CIIS), Portuguese Catholic University, 1649-023 Lisbon, Portugal
| | - Ricardo São-João
- Nursing Research, Innovation and Development Center of Lisbon (CIDNUR), 1600-096 Lisbon, Portugal (M.H.P.)
- School of Management and Technology, Polytechnic Institute of Santarém, 2001-904 Santarém, Portugal
- Statistics and Applications Center, University of Lisbon (CEAUL), 1749-016 Lisbon, Portugal
- Center for Global Studies, Universidade Aberta, 1250-100 Lisboa, Portugal
| | - Maria Helena Presado
- Nursing Research, Innovation and Development Center of Lisbon (CIDNUR), 1600-096 Lisbon, Portugal (M.H.P.)
- Nursing School of Lisbon, 1600-190 Lisbon, Portugal
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Meekers D, Elkins A, Obozekhai V. Tools for patient-centred family planning counselling: A scoping review. J Glob Health 2024; 14:04038. [PMID: 38303671 PMCID: PMC10846870 DOI: 10.7189/jogh.14.04038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Background The focus of family planning counselling is gradually shifting from the tiered-effectiveness model to patient-centred counselling. Although tools exist that aim to make family planning counselling more patient-oriented without increasing the provider's workload, they are not widely used. This scoping review aims to address this by identifying key tools to make family planning care more patient-centred, reviewing the domains of patient-centred care they address, and identifying gaps in the evidence base. Methods We systematically searched PubMed and SCOPUS for documents on 'patient-centred family planning counselling or support' published between 2013 and 2022. Eligibility criteria included discussion of: 1) strategies for providing patient-centred care; 2) interventions using a patient-centred approach; or 3) the impact of patient-centred approaches. We identified tools for patient-centred care, and mapped them against an existing framework of the main domains of patient-centred care. We reported the available evidence of the impact on those tools. Results Our scoping review is based on 33 documents. We identified six tools for increasing the patient-centeredness of family planning counselling. None of the tools addressed all domains of patient-centred care. Evidence about the impact of these tools remains scarce. Although there is some evidence about the acceptability of the tools, key evidence gaps include the effect of the tools on quality of care and family planning outcomes. Conclusions Family planning implementers should be aware that existing tools differ in the extent to which they address key domains of patient-centred family planning counselling. There is a need for further research on factors that may deter providers from adopting these tools. A larger evidence base is needed to permit a future systematic review to determine the effect of these tools on family planning outcomes, such as method adoption and continuation.
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Affiliation(s)
- Dominique Meekers
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Aaron Elkins
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Vivian Obozekhai
- DKT International, A. G. Leventis Building, Iddo House, Lagos Mainland, Lagos, Nigeria
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Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2024; 1:CD001431. [PMID: 38284415 PMCID: PMC10823577 DOI: 10.1002/14651858.cd001431.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patient decision aids are interventions designed to support people making health decisions. At a minimum, patient decision aids make the decision explicit, provide evidence-based information about the options and associated benefits/harms, and help clarify personal values for features of options. This is an update of a Cochrane review that was first published in 2003 and last updated in 2017. OBJECTIVES To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach. SEARCH METHODS We conducted the updated search for the period of 2015 (last search date) to March 2022 in CENTRAL, MEDLINE, Embase, PsycINFO, EBSCO, and grey literature. The cumulative search covers database origins to March 2022. SELECTION CRITERIA We included published randomized controlled trials comparing patient decision aids to usual care. Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened citations for inclusion, extracted intervention and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made (informed values-based choice congruence) and the decision-making process, such as knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision-making, and adverse events. Secondary outcomes were choice, confidence in decision-making, adherence to the chosen option, preference-linked health outcomes, and impact on the healthcare system (e.g. consultation length). We pooled results using mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs), applying a random-effects model. We conducted a subgroup analysis of 105 studies that were included in the previous review version compared to those published since that update (n = 104 studies). We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. MAIN RESULTS This update added 104 new studies for a total of 209 studies involving 107,698 participants. The patient decision aids focused on 71 different decisions. The most common decisions were about cardiovascular treatments (n = 22 studies), cancer screening (n = 17 studies colorectal, 15 prostate, 12 breast), cancer treatments (e.g. 15 breast, 11 prostate), mental health treatments (n = 10 studies), and joint replacement surgery (n = 9 studies). When assessing risk of bias in the included studies, we rated two items as mostly unclear (selective reporting: 100 studies; blinding of participants/personnel: 161 studies), due to inadequate reporting. Of the 209 included studies, 34 had at least one item rated as high risk of bias. There was moderate-certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants). Regarding attributes related to the decision-making process and compared to usual care, there was high-certainty evidence that patient decision aids result in improved participants' knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD -10.02, 95% CI -12.31 to -7.74; 58 studies, 12,104 participants), indecision about personal values (MD -7.86, 95% CI -9.69 to -6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision-making (clinician-controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants). For adverse outcomes, there was high-certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD -1.23, 95% CI -3.05 to 0.59; 22 studies, 3707 participants). Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD -2.97 minutes, 95% CI -7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants). We found the same direction of effect when we compared results for patient decision aid studies reported in the previous update compared to studies conducted since 2015. AUTHORS' CONCLUSIONS Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values-congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision-making. Our updated review also found that patient decision aids increased patients' feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisa E Douglas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Carol L Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paulina Bravo
- Education and Cancer Prevention, Fundación Arturo López Pérez, Santiago, Chile
| | - Karina Steffensen
- Center for Shared Decision Making, IRS - Lillebælt Hospital, Vejle, Denmark
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | | | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Bevilacqua KG, Tuchler AM, Carvajal DN. Provider perspectives on a point-of-care tool to facilitate patient-centered contraceptive care among Latina/x patients in Baltimore, MD. PEC INNOVATION 2023; 3:100190. [PMID: 37502428 PMCID: PMC10368902 DOI: 10.1016/j.pecinn.2023.100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/12/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023]
Abstract
Objectives To explore clinician perspectives on the development, utility, and feasibility of a provider-facing point-of-care tool to assist in provision of patient-centered contraceptive care for Latina/x patients in Baltimore, MD. Methods We conducted 25 semi-structured qualitative interviews with a sample of clinicians who provide contraceptive care to Latina/x patients. An interview guide was developed based on prior research related to patient-centered care and extant point-of-care tools. Transcripts were independently coded by two study team members and analyzed using a directed content analysis approach. Results Four themes emerged from the data: (1) clinician perception of a need for a tool to facilitate patient-centered contraceptive care, (2) concern for tool burden and burnout, (3) desire for tool ease of use, and (4) a need for cultural awareness during tool development to avoid bias and typecasting. Conclusions A provider-facing, point-of-care tool to facilitate patient-centered contraceptive counseling was acceptable among providers, provided the tool is easy to use and promotes cultural awareness. Innovation In the current era of more limited reproductive choice across the U.S., the need and support for non-coercive, patient-centered contraceptive care is timely. A provider-facing, point-of-care tool can facilitate the provision of patient-centered care among clinicians proving contraceptive counseling to Latina/s.
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Affiliation(s)
- Kristin G. Bevilacqua
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Diana N. Carvajal
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, USA
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Freeman E, Paul R, Dorsey M, Madden T. Comparison of interpersonal quality of contraceptive counseling delivered via telehealth versus in person. Contraception 2023; 128:110129. [PMID: 37499735 DOI: 10.1016/j.contraception.2023.110129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/11/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES This study aimed to compare the interpersonal quality of contraceptive counseling between telehealth and in-person visits. STUDY DESIGN Patients at a single Title X-funded clinic selected their preferred counseling modality (in person or telehealth via video or telephone) when scheduling an appointment for contraception. After counseling, we invited patients to complete a survey and recorded their desired contraceptive method. We assessed the quality of counseling using the Interpersonal Quality in Family Planning scale. We reviewed the electronic medical record to identify any subsequent clinician visit. We performed between-group comparisons using Mann-Whitney U, χ2, and Fisher exact tests. RESULTS From March 2021 to June 2022, 360 patients were eligible to participate, and 296 (82%) completed the survey and were included in the analysis; 150 (51%) completed counseling in person, and 146 (49%) completed counseling via telehealth. In the telehealth group, 102 (70%) chose telephone, and 44 (30%) chose video. Respondent characteristics were similar between groups. The majority of respondents in both groups reported high quality of counseling, defined as a top score on the Interpersonal Quality in Family Planning scale (75.0% telehealth respondents and 80.0% in person, p = 0.30). Compared to respondents completing in-person counseling, telehealth respondents were less likely to have a subsequent clinician visit (89.0% versus 100.0%, p < 0.001). CONCLUSIONS The majority of respondents reported high-quality contraceptive counseling without significant difference between the modalities. However, respondents choosing telehealth were less likely to have a subsequent clinician visit. Given the higher uptake of telephone compared to video, telehealth via telephone may be more accessible or acceptable to some patients. IMPLICATIONS Contraceptive counseling via telehealth has similar high interpersonal quality when compared to traditional, in-person visits. However, barriers may exist for patients who choose telehealth contraceptive counseling to access subsequent in-person care. Utilization of telehealth for contraceptive visits may provide opportunities for more equitable health care and to expand contraceptive access.
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Affiliation(s)
- Emily Freeman
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Department of Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Rachel Paul
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Megan Dorsey
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Tessa Madden
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Division of Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
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Athey S, Bergstrom K, Hadad V, Jamison JC, Özler B, Parisotto L, Sama JD. Can personalized digital counseling improve consumer search for modern contraceptive methods? SCIENCE ADVANCES 2023; 9:eadg4420. [PMID: 37801502 PMCID: PMC10558117 DOI: 10.1126/sciadv.adg4420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 09/05/2023] [Indexed: 10/08/2023]
Abstract
This paper analyzes a randomized controlled trial of a personalized digital counseling intervention addressing informational constraints and choice architecture, cross-randomized with discounts for long-acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs). The counseling intervention encourages shared decision-making (SDM) using a tablet-based app, which provides a tailored ranking of modern methods to each client according to their elicited needs and preferences. Take-up of LARCs in the status quo regime at full price was 11%, which increased to 28% with discounts. SDM roughly tripled the share of clients adopting a LARC at full price to 35%, and discounts had no incremental impact in this group. Neither intervention affected the take-up of short-acting methods, such as the pill. Consistent with theoretical models of consumer search, SDM clients discussed more methods in depth, which led to higher adoption rates for second- or lower-ranked LARCs. Our findings suggest that low-cost individualized recommendations can potentially be as effective in increasing unfamiliar technology adoption as providing large subsidies.
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Affiliation(s)
- Susan Athey
- Graduate School of Business, Stanford University, Stanford, CA 94305, USA
| | - Katy Bergstrom
- Department of Economics, Tulane University, New Orleans, LA 70118, USA
| | | | - Julian C. Jamison
- Business School, University of Exeter, Exeter EX44PU, UK
- Global Priorities Institute, Oxford University, Oxford OX2 0DJ, UK
| | - Berk Özler
- Development Research Group, The World Bank, Washington DC, DC 20433, USA
| | - Luca Parisotto
- Department of Economics, Bocconi University, Milano, MI 20100, Italy
| | - Julius Dohbit Sama
- Department of Gynaecology-Obstetrics, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital, Yaoundé, Cameroon
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Gutman S, Connor H, Mumford SL, Gilmore E, Roe AH, Schreiber CA. Feasibility and acceptability of virtual group contraceptive counseling prior to abortion care. Contraception 2023; 126:110114. [PMID: 37467921 DOI: 10.1016/j.contraception.2023.110114] [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: 12/09/2022] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES This study aimed to evaluate the feasibility and acceptability of virtual group contraceptive counseling in the abortion care setting. STUDY DESIGN Patients seeking abortion care at an urban university hospital were invited to participate in this cohort study. Prior to their clinical appointments, groups of two to six patients participated in 45-minute virtual contraceptive counseling visits facilitated by study staff. Contraceptive method use, effectiveness, and side effects were reviewed according to group interest. Participant satisfaction scores were collected immediately following the sessions. After their appointments, providers estimated the time spent on contraceptive counseling during the clinical visit. RESULTS Of 195 patients approached, 86 (44%) were enrolled. Fifty-seven (66%) enrolled patients completed a session. The most common reason for declining enrollment was concern about the time commitment. Most (93%) participants reported being "satisfied" or "very satisfied" overall, and 96% would recommend group contraceptive counseling to a friend. Providers reported that compared to typical counseling, participants required a shorter amount of time during the clinical visit than nonparticipants (time spent <5 minutes: 74% vs 54%). CONCLUSIONS Virtual group contraceptive counseling for patients seeking abortion was feasible and acceptable in this study. Group virtual visits may reduce provider time burden, add value when virtual care delivery is desired or required, and deserve further study. IMPLICATIONS Family planning clinics can consider incorporating virtual group counseling as a person-centered and efficient approach to contraceptive counseling at the time of abortion care.
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Affiliation(s)
- Sarah Gutman
- Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.
| | - Hannah Connor
- Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Sunni L Mumford
- Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Emma Gilmore
- Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Andrea H Roe
- Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Courtney A Schreiber
- Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
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Kus LH, Paul R, Nigaglioni Rivera A, Zeal C, Madden T. Improvement in contraceptive knowledge after using an online educational resource. Contraception 2023; 126:110095. [PMID: 37331460 PMCID: PMC10760799 DOI: 10.1016/j.contraception.2023.110095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/16/2023] [Accepted: 06/13/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES To measure the change in contraceptive knowledge after interaction with a web-based contraception education resource in an online cohort of potential users. STUDY DESIGN We conducted a cross-sectional online survey of reproductive-aged, biologically female respondents using Amazon Mechanical Turk. Respondents provided demographic characteristics and responded to 32 contraceptive knowledge questions. We assessed contraceptive knowledge before and after interaction with the resource and compared the number of correct answers using Wilcoxon signed-rank test. We used univariate and multivariable logistic regression to identify respondent characteristics associated with an increase in the number of correct answers. We calculated System Usability Scale scores to assess ease of use. RESULTS A convenience sample of 789 respondents were included in our analysis. Prior to resource use, respondents had a median of 17/32 correct contraceptive knowledge responses (interquartile range [IQR] 12-22). The number of correct answers increased to 21/32 (IQR 12-26, p < 0.001) after viewing the resource; 556 (70.5%) had an increase contraceptive knowledge. In adjusted analyses, respondents who were never married (adjusted odds ratio [aOR] 1.47, 95% CI 1.01-2.15), or thought decisions about birth control should be made by themselves (aOR 1.95, 95% CI 1.17-3.26) or in conjunction with a clinician (aOR 2.09, 95% CI 1.20-3.64) were more likely to have an increase in contraceptive knowledge. Respondents reported a median system usability score of 70 out of 100 (IQR 50-82.5). CONCLUSIONS These results support the effectiveness and usability of this online contraception education resource among this sample of online respondents. The educational resource could effectively augment contraceptive counseling in the clinical setting. IMPLICATIONS Use of an online contraception education resource improved contraceptive knowledge among reproductive-age users.
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Affiliation(s)
- Lauren H Kus
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Rachel Paul
- Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Adriana Nigaglioni Rivera
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Carley Zeal
- Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Department of Obstetrics and Gynecology, Mercy Health, Beloit, WI, United States
| | - Tessa Madden
- Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Division of Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States.
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Goueth R, Holt K, Eden KB, Hoffman A. Clinicians' Perspectives and Proposed Solutions to Improve Contraceptive Counseling in the United States: Qualitative Semistructured Interview Study With Clinicians From the Society of Family Planning. JMIR Form Res 2023; 7:e47298. [PMID: 37603407 PMCID: PMC10477923 DOI: 10.2196/47298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/14/2023] [Accepted: 07/04/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Contraceptive care is a key element of reproductive health, yet only 12%-30% of women report being able to access and receive the information they need to make these complex, personal health care decisions. Current guidelines recommend implementing shared decision-making approaches; and tools such as patient decision aid (PtDA) applications have been proposed to improve patients' access to information, contraceptive knowledge, decisional conflict, and engagement in decision-making and contraception use. To inform the design of meaningful, effective, elegant, and feasible PtDA applications, studies are needed of all users' current experiences, needs, and barriers. While multiple studies have explored patients' experiences, needs, and barriers, little is known about clinicians' experiences, perspectives, and barriers to delivering contraceptive counseling. OBJECTIVE This study focused on assessing clinicians' experiences, including their perspectives of patients' needs and barriers. It also explored clinicians' suggestions for improving contraceptive counseling and the feasibility of a contraceptive PtDA. METHODS Following the decisional needs assessment approach, we conducted semistructured interviews with clinicians recruited from the Society of Family Planning. The Ottawa Decision Support Framework informed the interview guide and initial codebook, with a specific focus on decision support and decisional needs as key elements that should be assessed from the clinicians' perspective. An inductive content approach was used to analyze data and identify primary themes and suggestions for improvement. RESULTS Fifteen clinicians (12 medical doctors and 3 nurse practitioners) participated, with an average of 19 years of experience in multiple regions of the United States. Analyses identified 3 primary barriers to the provision of quality contraceptive counseling: gaps in patients' underlying sexual health knowledge, biases that impede decision-making, and time constraints. All clinicians supported the development of contraceptive PtDAs as a feasible solution to these main barriers. Multiple suggestions for improvement were provided, including clinician- and system-level training, tools, and changes that could support successful implementation. CONCLUSIONS Clinicians and developers interested in improving contraceptive counseling and decision-making may wish to incorporate approaches that assess and address upstream factors, such as sexual health knowledge and existing heuristics and biases. Clinical leaders and administrators may also wish to prioritize solutions that improve equity and accessibility, including PtDAs designed to provide education and support in advance of the time-constrained consultations, and strategic training opportunities that support cultural awareness and shared decision-making skills. Future studies can then explore whether well-designed, user-centered shared decision-making programs lead to successful and sustainable uptake and improve patients' reproductive health contraceptive decision-making.
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Affiliation(s)
- Rose Goueth
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
| | - Kelsey Holt
- Department of Family Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Karen B Eden
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
| | - Aubri Hoffman
- Value Institute for Health & Care, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
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Celum C, Seidman D, Travill D, Dehlendorf C, Gumede S, Zewdie K, Wilson W, Morton JF, Baeten JM, Donnell D, Delany‐Moretlwe S. A decision support tool has similar high PrEP uptake and increases early PrEP persistence in adolescent girls and young women in South Africa: results from a randomized controlled trial. J Int AIDS Soc 2023; 26:e26154. [PMID: 37634942 PMCID: PMC10460672 DOI: 10.1002/jia2.26154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 08/15/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION African adolescent girls and young women (AGYW) have high rates of HIV acquisition and are a priority population for HIV pre-exposure prophylaxis (PrEP). PrEP implementation has been limited by AGYW's low perceived HIV risk and provider demands. A decision support tool (DST) with information about PrEP could improve clients' risk perception, knowledge about PrEP, informed decision-making and motivation to use PrEP based on their risk, facilitating PrEP delivery in primary healthcare (PHC) clinics. METHODS We designed MyPrEP, a client-facing DST about PrEP and HIV prevention, with youth-friendly information and images. The impact of the MyPrEP tool was assessed among HIV-negative women aged 18-25 years presenting to a PHC clinic in Johannesburg, South Africa from March 2019 to 2020. AGYW were randomized by day to the DST or a general health website as the control condition. A clinician blinded to DST versus control allocation provided standard of care counselling about PrEP, offered PrEP, administered a questionnaire and conducted sexually transmitted infection testing. The primary outcome was PrEP initiation and the secondary outcome was PrEP persistence at 1 month, determined by pharmacy dispensation records. RESULTS Of 386 AGYW screened, 353 were randomized (DST n = 172, control n = 181) with a median age of 21 years (interquartile range [IQR] 20, 23) and 56% (199/353) attending the clinic for HIV testing, 46% (164/353) using contraception, 15% (53/353) using condoms consistently and 37% (108/353) with a curable sexually transmitted infection. PrEP was initiated by 97% in the DST group and 94% in the control group (OR 1.79; 95% confidence interval, CI = 0.79-1.53), of whom two-thirds planned to continue PrEP until they decided if they liked PrEP. At 1 month, PrEP persistence was 19% in the DST and 10% in the control group (OR 1.97, 95% CI 1.08-3.69). Ninety-nine percent randomized to the DST reported satisfaction with MyPrEP. CONCLUSIONS Among AGYW attending a South African PHC clinic, PrEP uptake was >90% with two-fold higher PrEP persistence at 1 month in those randomized to use the MyPrEP DST. Given the need for strategies to support PrEP implementation and improve low PrEP persistence among African AGYW, a PrEP DST warrants further evaluation.
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Affiliation(s)
- Connie Celum
- Departments of Global HealthMedicine and EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Dominika Seidman
- Department of ObstetricsGynecology & Reproductive SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | | | - Christine Dehlendorf
- Department of Family & Community MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Sanele Gumede
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Kidist Zewdie
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Whitney Wilson
- Department of Family & Community MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | | | - Jared M. Baeten
- Departments of Global HealthMedicine and EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Gilead SciencesInc.Foster CityCaliforniaUSA
| | - Deborah Donnell
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
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Phillips AK, Keller MF, McClung JP, Steele N, Witkop CT, Wu TJ. Physical Health and Well-being: Updates and the Way Ahead. Mil Med 2023; 188:9-18. [PMID: 37490559 DOI: 10.1093/milmed/usac370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 02/24/2022] [Accepted: 11/14/2022] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION The Women in Combat Summit 2021 "Forging the Future: How Women Enhance the Fighting Force" took place during February 9-11, 2021, via a virtual conference platform. The third and final day of the Summit regarded the physical health and well-being of military women and included the topics of urogenital health, nutrition and iron-deficiency anemia, unintended pregnancy and contraception, and traumatic brain injury. MATERIALS AND METHODS After presentations on the topics earlier, interested conference attendees were invited to participate in focus groups to discuss and review policy recommendations for physical health and well-being in military women. Discussions centered around the topics discussed during the presentations, and suggestions for future Women in Combat Summits were noted. Specifics of the methods of the Summit are presented elsewhere in this supplement. RESULTS We formulated research and policy recommendations for urogenital health, nutrition and iron-deficiency anemia, contraception and unintended pregnancy, and traumatic brain injury. CONCLUSIONS In order to continue to develop the future health of military women, health care providers, researchers, and policymakers should consider the recommendations made in this supplement as they continue to build on the state of the science and forge the future.
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Affiliation(s)
- Angela K Phillips
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD 20762, USA
| | - Margaux F Keller
- Henry Jackson Foundation at the Daniel K. Inouye Graduate School of Nursing, Uniformed Services University, Bethesda, MD 20814, USA
| | - James P McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Nancy Steele
- School of Nursing, University of North Florida, Jacksonville, FL 32224, USA
| | - Catherine T Witkop
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD 20814, USA
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University, Bethesda, MD 20814, USA
| | - T John Wu
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University, Bethesda, MD 20814, USA
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15
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Dehlendorf C, Vittinghoff E, Silverstein I, Fox E, Logan R, Reed R, Jones E, Jones DH. Prioritizing patient experience: Validation of the person-centered contraceptive counseling measure as a performance measure. Contraception 2023; 123:110010. [PMID: 36934954 DOI: 10.1016/j.contraception.2023.110010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/03/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE A performance measure assessing how often patients experience patient-centered contraceptive counseling can inform quality improvement in contraceptive care and enable efforts to enhance equity in the provision of this care. We sought to test the validity and reliability of the Person-Centered Contraceptive Counseling (PCCC) measure as a performance measure, in preparation for application for endorsement from the National Quality Forum. STUDY DESIGN We combined data from two research studies, a statewide quality improvement assessment, and a dedicated data collection effort at nine sites, all collected between 2009 and 2019 at 22 total sites in the United States, to evaluate the validity and reliability of the four-item PCCC measure aggregated at the provider and facility level. We scored the PCCC dichotomously as a "top-box" score of 20 versus less than 20. We assessed reliability using the Spearman-Brown coefficient, and validity by comparing scores on the PCCC to aggregated scores on single-item measures of patient satisfaction. RESULTS We included 22 facilities and 34 providers in the analyses. The average PCCC top-box score by provider and facility was 81% and 79%, respectively. We found adequate reliability with panel sizes of 20-50. PCCC scores were strongly associated with the single-item measures of satisfaction. There were notable disparities by race/ethnicity and language (Spanish vs English) in PCCC scores. DISCUSSION The PCCC is a valid and reliable performance measure for use at the provider and facility level. The development and use of the measures of patient experience, like the PCCC, is critical for prioritizing patient-centeredness in reproductive health care. IMPLICATIONS The PCCC measure can facilitate the identification of gaps and disparities in patient-centered contraceptive counseling and enable quality improvement to promote quality, equitable contraceptive care. Using this measure provides the opportunity to enhance patient experience of care and build trust between contraceptive providers and the communities they serve.
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Affiliation(s)
- Christine Dehlendorf
- Department of Family & Community Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA.
| | - Eric Vittinghoff
- Department of Family & Community Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA.
| | - Ilana Silverstein
- Department of Family & Community Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA.
| | - Edith Fox
- Department of Family & Community Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA.
| | - Rachel Logan
- Department of Family & Community Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA.
| | - Reiley Reed
- Department of Family & Community Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA.
| | - Elizabeth Jones
- National Family Planning and Reproductive Health Association, 1025 Vermont Ave. NW, Suite 800, Washington, DC 20005, USA.
| | - Danielle Hessler Jones
- Department of Family & Community Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA.
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Mruts KB, Tessema GA, Kassaw NA, Gebremedhin AT, Scott JA, Pereira G. Achieving reductions in the unmet need for contraception with postpartum family planning counselling in Ethiopia, 2019-2020: a national longitudinal study. Arch Public Health 2023; 81:79. [PMID: 37127656 PMCID: PMC10150151 DOI: 10.1186/s13690-023-01096-1] [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: 04/28/2022] [Accepted: 04/23/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND An unmet need for contraception is associated with unintended pregnancy and adverse maternal and childhood outcomes. Family planning counselling is linked with reduced unmet need for contraception. However, evidence is lacking in Ethiopia on the impact of integrated family planning counselling on the unmet need for contraception. This study aimed to examine the association between family planning counselling and the unmet need for contraception in Ethiopia. METHODS We used community-based prospective cohort study data from a nationally representative survey conducted by Performance Monitoring for Action Ethiopia between 2019 and 2020. Women who had received three maternal and child health (MCH) services (n = 769) - antenatal care (ANC), facility delivery and child immunisation - were included in this study. The primary exposure variable was family planning counselling provided during the different MCH services. A weighted modified Poisson regression model was used to estimate the adjusted relative risk (aRR) of the unmet need for contraception. RESULTS The prevalence of family planning counselling during ANC, prior to discharge, and child immunisation was 22%, 28%, and 28%, respectively. Approximately one-third (34%) of the women had an unmet need for contraception. Family planning counselling prior to discharge from the facility was associated with reductions in the unmet need for contraception (aRR 0.88; 95% CI 0.67, 1.16). The risk of unmet need for contraception was 31% (aRR 0.69; 95% CI 0.48, 0.98) less likely among women who had received family planning counselling during child immunisation services. However, family planning counselling during ANC was associated with an increased unmet need for contraception (aRR 1.24; 95% CI 0.93, 1.64). CONCLUSION Strongest evidence was observed for moderate associations between reductions in the unmet need for contraception and family planning counselling during the provision of child immunisation services in Ethiopia.
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Affiliation(s)
- Kalayu Brhane Mruts
- School of Public Health, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia.
- Curtin School of Population Health, Curtin University, Perth, Australia.
| | - Gizachew A Tessema
- Curtin School of Population Health, Curtin University, Perth, Australia
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Nigussie Assefa Kassaw
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Jane A Scott
- Curtin School of Population Health, Curtin University, Perth, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Australia
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Burke KL, Potter JE. Meeting Preferences for Specific Contraceptive Methods: An Overdue Indicator. Stud Fam Plann 2023; 54:281-300. [PMID: 36705876 DOI: 10.1111/sifp.12218] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Fertility surveys have rarely asked people who are using contraception about the contraceptive method they would like to be using, implicitly assuming that those who are contracepting are using the method they want. In this commentary, we review evidence from a small but growing body of work that oftentimes indicates this assumption is untrue. Discordant contraceptive preferences and use are relatively common, and unsatisfied preferences are associated with higher rates of method discontinuation and subsequent pregnancy. We argue that there is opportunity to center autonomy and illuminate the need for and quality of services by building on this research and investing in the development of survey items that assess which method people would like to use, as well as their reasons for nonpreferred use. The widespread adoption of questions regarding method preferences could bring indicators of reproductive health services into closer alignment with the needs of the people they serve.
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Affiliation(s)
- Kristen Lagasse Burke
- Population Research Center and Department of Sociology, University of Texas at Austin, Austin, TX, 78712, USA
| | - Joseph E Potter
- Population Research Center and Department of Sociology, University of Texas at Austin, Austin, TX, 78712, USA
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Galavotti C, Gullo S. Reproductive power matters: aligning actions with values in global family planning. Sex Reprod Health Matters 2022; 30:2082353. [PMID: 35904528 PMCID: PMC9341371 DOI: 10.1080/26410397.2022.2082353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Sara Gullo
- Independent Consultant, Atlanta, GA, USA
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Dolan H, Bateson D, Li M, Thompson R, Tam CWM, Bonner C, Trevena L. Acceptability and perceived feasibility of adapted encounter decision aids on contraceptive methods: An interview study with healthcare providers and Chinese migrant women. PEC INNOVATION 2022; 1:100031. [PMID: 37213744 PMCID: PMC10194123 DOI: 10.1016/j.pecinn.2022.100031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/02/2022] [Accepted: 03/17/2022] [Indexed: 05/23/2023]
Abstract
Objective This study aimed to explore the perceived acceptability, usefulness, and feasibility of a suite of encounter decision aids (DAs) on contraceptive methods with Chinese migrant women living in Australia and healthcare providers. Methods Semi-structured in-depth interviews with 22 Chinese migrant women and twenty healthcare providers were conducted. Transcribed data were analysed using the qualitative content analysis method. Results Women perceived the DAs to be informative and useful. They suggested making the DAs available outside the clinical settings. Healthcare providers perceived the DAs to be comprehensive and valuable in informing women about contraceptive methods. Some providers had concerns as to the information load and the length of the DAs. Such concerns were eased when provided with an explanation of how to use the DAs. Most women and healthcare providers preferred the numerical format for side-effect probability information presentation. Conclusion Making the encounter DAs available in both the Chinese and English languages can be valuable in assisting Chinese migrant women in making informed decisions about contraceptive methods. Innovation This study is the first to evaluate the acceptability and perceived feasibility of patient decision aids with members of a migrant community in Australia. The findings highlight the need for disseminating the DAs both within and outside the clinical settings.
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Affiliation(s)
- Hankiz Dolan
- Ask, Share, Know: Rapid Evidence for General Practice Decision (ASK-GP), Centre for Research Excellence, The University of Sydney, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Corresponding author at: Room 125, Edward Ford Building, The University of Sydney, Sydney, Australia.
| | - Deborah Bateson
- Family Planning NSW, Sydney, Australia
- Specialty of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, Australia
| | - Mu Li
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Rachel Thompson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Chun Wah Michael Tam
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Sydney, Australia
- School of Population Health, Faculty of Medicine, UNSW, Sydney, Australia
| | - Carissa Bonner
- Ask, Share, Know: Rapid Evidence for General Practice Decision (ASK-GP), Centre for Research Excellence, The University of Sydney, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Lyndal Trevena
- Ask, Share, Know: Rapid Evidence for General Practice Decision (ASK-GP), Centre for Research Excellence, The University of Sydney, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
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20
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Zeal C, Paul R, Dorsey M, Politi MC, Madden T. Young women's preferences for contraceptive education & development of an online educational resource. PEC INNOVATION 2022; 1:100046. [PMID: 37213738 PMCID: PMC10194227 DOI: 10.1016/j.pecinn.2022.100046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 05/23/2023]
Abstract
Objectives To explore young women's preferences for contraceptive education to inform the development of an educational resource and to pilot test the resource with patients and clinicians. Methods We performed a mixed-methods study to elicit preferences for contraceptive educational resources among patients, develop an online resource, and pilot test the resource with clinicians and patients to assess feasibility, systems usability, and contraceptive knowledge. Results Forty-one women aged 16-29 completed in-depth interviews: they preferred an online format which was recommended by a clinician, presented contraceptive methods in order of effectiveness, and contained information from experts and experiences from individual users. We adapted an existing website (bedsider.org) to create an online educational resource. Thirty clinicians and thirty patients completed surveys after use. System Usability Scale scores were high among patients (median [IQR]: 80 [72-86]) and clinicians (84 [75-90]). Patients answered more contraceptive knowledge questions correctly after interacting with the resource (9.9±2.7 vs 12.0±2.8, p<0.001). Conclusions We developed a contraceptive educational resource incorporating end-user feedback that was highly usable and increased patients' contraceptive knowledge. Future research should assess effectiveness and scalability among a larger sample of patients. Innovation This contraceptive educational resource can supplement clinician counseling to increase patient contraceptive knowledge.
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Affiliation(s)
- Carley Zeal
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Department of Obstetrics and Gynecology, Mercy Health – Beloit, Beloit, WI, USA
| | - Rachel Paul
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Megan Dorsey
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Mary C. Politi
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Tessa Madden
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Corresponding author at: Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, 4901 Forest Park Avenue, Mailstop: 8064-37-1005, St. Louis, MO 63108, USA.
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Callegari LS, Benson SK, Mahorter SS, Nelson KM, Arterburn DE, Hamilton AB, Taylor L, Hunter-Merrill R, Gawron LM, Dehlendorf C, Borrero S. Evaluating the MyPath web-based reproductive decision support tool in VA primary care: Protocol for a pragmatic cluster randomized trial. Contemp Clin Trials 2022; 122:106940. [PMID: 36179982 DOI: 10.1016/j.cct.2022.106940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Counseling to identify and support individuals' desires for family formation is a key component of preventive health care that is often absent in primary care visits. This study evaluates a novel, web-based, person-centered intervention to increase the frequency and quality of communication about reproductive goals and healthcare needs in Veterans Health Administration (VA) primary care. METHODS We describe a hybrid type 1 effectiveness-implementation cluster randomized controlled trial in seven VA healthcare systems testing a web-based reproductive health decision support tool (MyPath). VA primary care providers are enrolled and randomized to intervention or usual care arms. Veterans scheduled to see intervention-arm providers receive a text message inviting them to use MyPath ahead of their appointment; Veterans scheduled to see control-arm providers receive usual care. Target enrollment is 36 providers and 456 Veterans. Outcomes are assessed by Veteran self-report after the visit and at 3- and 6-months follow-up. The primary outcome is occurrence of reproductive health discussions involving shared decision making; secondary outcomes include measures of communication, knowledge, decision conflict, contraceptive utilization, and receipt of services related to prepregnancy health. Data on implementation barriers, facilitators and cost are collected. RESULTS The trial is ongoing with no results to report. We have enrolled 36 primary care providers across 7 VA healthcare systems and recruitment of Veterans is ongoing. CONCLUSIONS Results will inform efforts to increase the quality and person-centeredness of reproductive healthcare delivery in primary care and to operationalize and scale up use of digital decision support tools in clinical settings. TRIAL REGISTRATION http://ClinicalTrials.gov Identifier: NCT04584294 Trial Status: Recruiting.
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Affiliation(s)
- Lisa S Callegari
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA; Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA.
| | - Samantha K Benson
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA
| | - Siobhan S Mahorter
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA
| | - Karin M Nelson
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA; Department of Medicine, University of Washington School of Medicine, Seattle, USA
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Alison B Hamilton
- Health Services Research and Development, VA Greater Los Angeles Healthcare System, Los Angeles, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, USA
| | - Leslie Taylor
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA
| | - Rachel Hunter-Merrill
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, USA
| | - Lori M Gawron
- Health Services Research and Development, VA Salt Lake City Health Care System, Salt Lake City, USA; Department of Obstetrics & Gynecology, University of Utah School of Medicine, Salt Lake City, USA
| | - Christine Dehlendorf
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, USA
| | - Sonya Borrero
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, USA; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
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22
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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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23
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Yam EA, Namukonda E, McClair T, Souidi S, Chelwa N, Muntalima N, Mbizvo M, Bellows B. Developing and Testing a Chatbot to Integrate HIV Education Into Family Planning Clinic Waiting Areas in Lusaka, Zambia. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100721. [PMID: 36316140 PMCID: PMC9622293 DOI: 10.9745/ghsp-d-21-00721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND To maximize protection against both unintended pregnancy and HIV, it is important that family planning (FP) services integrate HIV counseling, both to support method choice and identify potential HIV services of interest, such as pre-exposure prophylaxis (PrEP). However, FP providers often lack sufficient time and knowledge to address HIV vulnerability with clients. To potentially offload some of the initial HIV counseling burden from FP providers, we developed and tested a chatbot that provided information about HIV and dual protection to FP clients in waiting areas of FP clinics in Lusaka, Zambia. CHATBOT DEVELOPMENT We drafted a scripted conversation and tested it in English in formative workshops with Zambian women between the ages of 15 and 49 years. After translating the content to Bemba and Nyanja, we conducted a second round of workshops to validate the translations, before uploading the content into the chatbot platform. CHATBOT USER TEST Thirty volunteers tested the chatbot in 3 Lusaka FP clinics, completing an exit survey to provide feedback. A large majority (83%) said they learned new HIV information from the chatbot. Twenty (67%) learned about PrEP for the first time through the chat. Most (96%) reported discussing HIV with the provider, after engaging with the chatbot. In response to an open-ended question, several testers volunteered that they wanted to learn more about PrEP. CONCLUSIONS Pre-consultation waiting-area time is an underutilized opportunity to impart HIV information to FP clients, thereby preparing them to discuss their dual HIV and pregnancy prevention needs when they see their providers. FP clients expressed particular interest in learning more about PrEP, underscoring the importance of integrating HIV into FP services.
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Affiliation(s)
| | | | | | - Samir Souidi
- International Rescue Committee, New York, NY, USA
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24
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Rocca CH, Smith MG, Hale NL, Khoury AJ. Ranges of pregnancy preferences and contraceptive use: Results from a population-based survey in the southeast United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:90-98. [PMID: 36071572 DOI: 10.1363/psrh.12205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CONTEXT Understanding how pregnancy preferences shape contraceptive use is essential for guiding contraceptive interventions and policies that center individuals' preferences and desires. Lack of rigorous measurement of pregnancy preferences, particularly on the population level, has been a methodologic challenge. METHODS We investigated associations between prospective pregnancy preferences, measured with a valid instrument, the Desire to Avoid Pregnancy (DAP) scale, and contraceptive use in a representative sample of 2601 pregnancy-capable self-identified women, aged 18-44 years, in Alabama and South Carolina (2017-2018). We used multivariable regression with weighting to investigate how probability of modern contraceptive use, and use of different contraceptive method types, changed with increasing preference to avoid pregnancy. RESULTS Desire to Avoid Pregnancy scale scores (range:0-4, 4 = greater preference to avoid pregnancy, median = 2.29, IQR: 1.57-3.14; α:0.95) were strongly associated with contraceptive use among sexually active respondents (aPR = 1.15 [1.10, 1.20]; predicted 45% using contraception among DAP = 0, 62% among DAP = 2, 86% among DAP = 4). Method types used did not differ by DAP score. The most common reasons for nonuse were concern over side effects and not wanting to use a method (32% each) among respondents with mid-range and high DAP scores. Among those with mid-range DAP scores, 20% reported nonuse due to not minding if pregnancy were to occur (vs. 0% among those with high DAP scores). CONCLUSIONS Pregnancy preferences strongly influence likelihood of contraceptive use. Providion of appropriate contraceptive care to those not explicitly desiring pregnancy must differentiate between ranges of feelings about pregnancy, perceived drawbacks to contraceptive use, and legitimate psychological and interpersonal benefits of nonuse to promote autonomy in contraceptive decision-making.
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Affiliation(s)
- Corinne H Rocca
- Department of Obstetrics, Gynecology and Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, School of Medicine, Oakland, California, USA
| | - Michael G Smith
- College of Public Health, Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee, USA
| | - Nathan L Hale
- College of Public Health, Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amal J Khoury
- College of Public Health, Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee, USA
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25
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Nelson HD, Cantor A, Jungbauer RM, Eden KB, Darney B, Ahrens K, Burgess A, Atchison C, Goueth R, Fu R. Effectiveness and Harms of Contraceptive Counseling and Provision Interventions for Women : A Systematic Review and Meta-analysis. Ann Intern Med 2022; 175:980-993. [PMID: 35605239 PMCID: PMC10185303 DOI: 10.7326/m21-4380] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The effectiveness and harms of contraceptive counseling and provision interventions are unclear. PURPOSE To evaluate evidence of the effectiveness of contraceptive counseling and provision interventions for women to increase use of contraceptives and reduce unintended pregnancy, as well as evidence of their potential harms. DATA SOURCES English-language searches of Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, SocINDEX, and MEDLINE (1 January 2000 to 3 February 2022) and reference lists of key studies and systematic reviews. STUDY SELECTION Randomized controlled trials of interventions providing enhanced contraceptive counseling, contraceptives, or both versus usual care or an active control. DATA EXTRACTION Dual extraction and quality assessment of studies; results combined using a profile likelihood random-effects model. DATA SYNTHESIS A total of 38 trials (43 articles [25 472 participants]) met inclusion criteria. Contraceptive use was higher with various counseling interventions (risk ratio [RR], 1.39 [95% CI, 1.16 to 1.72]; I 2 = 85.3%; 10 trials), provision of emergency contraception in advance of use (RR, 2.12 [CI, 1.79 to 2.36]; I 2 = 0.0%; 8 trials), and counseling or provision postpartum (RR, 1.15 [CI, 1.01 to 1.52]; I 2 = 6.6%; 5 trials) or at the time of abortion (RR, 1.19 [CI, 1.09 to 1.32]; I 2 = 0.0%; 5 trials) than with usual care or active controls in multiple clinical settings. Pregnancy rates were generally lower with interventions, although most trials were underpowered and did not distinguish pregnancy intention. Interventions did not increase risk for sexually transmitted infections (STIs) (RR, 1.05 [CI, 0.87 to 1.25]; I 2 = 0.0%; 5 trials) or reduce condom use (RR, 1.03 [CI, 0.94 to 1.13]; I 2 = 0.0%; 6 trials). LIMITATION Interventions varied; few trials were adequately designed to determine unintended pregnancy outcomes. CONCLUSION Contraceptive counseling and provision interventions that provide services beyond usual care increase contraceptive use without increasing STIs or reducing condom use. Contraceptive care in clinical practice could be improved by implementing enhanced contraceptive counseling, provision, and follow-up; providing emergency contraception in advance; and delivering contraceptive services immediately postpartum or at the time of abortion. PRIMARY FUNDING SOURCE Resources Legacy Fund. (PROSPERO: CRD42020192981).
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Affiliation(s)
- Heidi D Nelson
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California (H.D.N.)
| | - Amy Cantor
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
| | - Rebecca M Jungbauer
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
| | - Karen B Eden
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
| | - Blair Darney
- Oregon Health & Science University and Portland State University School of Public Health, Portland, Oregon, and Instituto Nacional de Salud Pública, Centro de Investigación en Salud Poblacional, Cuernavaca, México (B.D.)
| | - Katherine Ahrens
- University of Southern Maine Muskie School of Public Service, Portland, Maine (K.A., A.B.)
| | - Amanda Burgess
- University of Southern Maine Muskie School of Public Service, Portland, Maine (K.A., A.B.)
| | - Chandler Atchison
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
| | - Rose Goueth
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
| | - Rongwei Fu
- Oregon Health & Science University, Portland, Oregon (A.C., R.M.J., K.B.E., C.A., R.G., R.F.)
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26
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Chernick LS, Konja A, Gonzalez A, Stockwell MS, Ehrhardt A, Bakken S, Westhoff CL, Dayan PS, Santelli J. Designing illustrative social media stories to promote adolescent peer support and healthy sexual behaviors. Digit Health 2022; 8:20552076221104660. [PMID: 35707267 PMCID: PMC9189520 DOI: 10.1177/20552076221104660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/14/2022] [Indexed: 12/31/2022] Open
Abstract
Objective Adolescent females in the United States continue to have unmet sexual and reproductive healthcare needs. Research shows that interventions incorporating peer support can augment perceived self-efficacy and reinforce healthy behaviors. Yet, few user-centered digital sexual health interventions incorporate peer support, and aim to change perceptions of peer norms and model social skills. The objective of this study was to design and demonstrate the receptivity of adolescent females to illustrated digital social media stories that promote healthy sexual behaviors and peer social support. Methods We conducted a three-phase study approved by our Institutional Review Board. In Phase 1, we presented sexually active adolescent female emergency department patients aged 14-19 with eight sexual health scenarios via a survey study. Participants wrote three text messages addressed to the protagonist of each scenario which motivated and encouraged her to consider the use of contraceptives. Messages were scored based on the construct of peer support (emotional, tangible, informational, and belonging). In Phase 2, we worked with a professional artist and screenwriter to design digital sexual health comics using the gathered messages. In Phase 3, we gathered feedback on the comics from adolescent female emergency department patients. Results Females (n = 22) provided 352 messages. Using top rated messages, we designed five digital visualizations in a running story called Mari tells it like it is. Each story incorporated 5-12 peer-authored quotes. We inserted the final images into Instagram®. Additional females (n = 39) found the images "relatable," "super-realistic," and "educational." Conclusion Collecting peer-authored texts from our local adolescent community led to the creation of well-received sexual health visualizations. This novel method of design incorporated adolescent voices to promote peer support and healthy behaviors.
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Affiliation(s)
- Lauren S Chernick
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA,Lauren S Chernick, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, 3959 Broadway, CHN 1-116, New York, NY, USA.
| | - Alexis Konja
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Ariana Gonzalez
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA
| | - Melissa S Stockwell
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA,Department of Child and Adolescent Health, Columbia University Medical Center, New York, NY, USA
| | - Anke Ehrhardt
- Department of Psychology, Columbia University Medical Center, New York, NY, USA
| | - Susanne Bakken
- Department of Nursing and Bioinformatics, Columbia University Medical Center, New York, NY, USA
| | - Carolyn L Westhoff
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA,Department of Obstetrics-Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Peter S Dayan
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA
| | - John Santelli
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA,Department of Child and Adolescent Health, Columbia University Medical Center, New York, NY, USA
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27
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Thiel de Bocanegra H, Dehlendorf C, Kuppermann M, Vangala SS, Moscicki AB. Impact of an educational tool on young women's knowledge of cervical cancer screening recommendations. Cancer Causes Control 2022; 33:813-821. [PMID: 35312891 PMCID: PMC9085671 DOI: 10.1007/s10552-022-01569-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 03/03/2022] [Indexed: 10/27/2022]
Abstract
PURPOSE Current cervical cancer screening guidelines recommend 3-year screening intervals, in contrast to the previous recommendation of annual screening, to prevent over screening and overtreatment. We evaluated the impact of viewing a tablet-based educational tool prior to seeing a clinician on young women's knowledge and understanding of cervical cancer screening, HPV vaccination follow-up of abnormal pap smears, and comfort in communicating with their providers. METHODS This cross-sectional study was part of a cluster-randomized study of fourteen primary care clinics from January 2015 to December 2016. We developed the cervical cancer education tool in English and Spanish using a community-based approach that included formative work and cognitive interviewing. Clinics were randomized to use the intervention (tablet-based patient education tool) or to participate as a control group. We administered surveys to a convenience sample of 229 English- or Spanish-speaking women aged 19 to 35 years in these clinics. We used descriptive analyses and logistic regression models with cluster-robust standard errors to compare differences among the two groups. RESULTS Compared to women seen in control clinics, women seen in intervention clinics demonstrated greater knowledge regarding human papilloma virus (HPV (p = 0.004) and understanding (p < 0.001) of cervical cancer screening. Comfort in communicating with providers was not statistically different (p = 0.053). Women in the intervention group felt that the tool helped them understand that an abnormal Pap smear does not require immediate treatment (61.5%). CONCLUSION Innovative online patient education that is offered prior to patients' interaction with their clinicians can improve their knowledge about cervical cancer prevention and treatment.
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Affiliation(s)
- Heike Thiel de Bocanegra
- Department of Obstetrics and Gynecology, School of Medicine, University of California, Irvine, 333 City Boulevard West, Suite 1400, Orange, CA, 92868, USA.
| | - Christine Dehlendorf
- Department of Family & Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, USA.,Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, USA.,Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, USA.,Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Sitaram S Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA
| | - Anna-Barbara Moscicki
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA
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28
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Gertz AM, Soffi ASM, Mompe A, Sickboy O, Gaines AN, Ryan R, Mussa A, Bawn C, Gallop R, Morroni C, Crits-Christoph P. Developing an Assessment of Contraceptive Preferences in Botswana: Piloting a Novel Approach Using Best-Worst Scaling of Attributes. Front Glob Womens Health 2022; 3:815634. [PMID: 35663924 PMCID: PMC9157818 DOI: 10.3389/fgwh.2022.815634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction To develop an attribute-based method for assessing patient contraceptive preferences in Botswana and pilot its use to explore the relationship between patient contraceptive preferences and the contraceptive methods provided or recommended to patients by clinicians. Methods A list of contraceptive attributes was developed with input from patients, clinicians, and other stakeholders. We assessed patient preferences for attributes of contraceptives using a discrete choice "best-worst scaling" approach and a multi-attribute decision-making method that linked patient attribute preferences to actual contraceptive method characteristics. Attribute-based patient method preferences and clinician recommendations were compared in 100 women seeking contraceptive services, and 19 clinicians who provided their care. For 41 of the patients, the short-term reliability of their preference scores was also examined. Results For 57 patients who wanted more children in the future, the degree of concordance between patients and clinicians was 7% when comparing the top attribute-based contraceptive preference for each woman with the clinician-provided/recommended method. When the top two model-based preferred contraceptive methods were considered, concordance was 28%. For 43 women who did not want more children, concordance was 0% when using the patient's model-based "most-preferred" method, and 14% when considering the top two methods. Assessment of the short-term reliability of preference scores yielded an intraclass correlation coefficient of 0.93. Conclusions A best-worst scaling assessment of attributes of contraceptives was designed and piloted in Botswana as a Contraceptive Preference Assessment Tool. The preference assessment was found to have high short-term reliability, which supports its potential use as a measurement tool. There was very low concordance between women's attribute-based contraceptive preferences and their clinician's provision/recommendations of contraceptive methods. Using such a preference assessment tool could encourage greater patient involvement and more tailored discussion in contraceptive consultations.
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Affiliation(s)
- Alida M. Gertz
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Atlang Mompe
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | | | - Averi N. Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Rebecca Ryan
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Aamirah Mussa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Caitlin Bawn
- Sexual and Reproductive Health Department, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Robert Gallop
- West Chester University, West Chester, PA, United States
| | - Chelsea Morroni
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Medical Research Council (MRC) University of Edinburgh Centre for Reproductive Health, The Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Paul Crits-Christoph
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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29
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Stransky OM, Pam M, Ladores SL, Birru Talabi M, Borrero S, Godfrey EM, Roe AH, Sawicki GS, Zuckerwise LC, Mody S, Mentch L, Deal A, O’Leary R, Taylor-Cousar JL, Jain R, Kazmerski TM. Engaging Stakeholders in the Development of a Reproductive Goals Decision AID for Women with Cystic Fibrosis. J Patient Exp 2022; 9:23743735221077527. [PMID: 35128042 PMCID: PMC8814976 DOI: 10.1177/23743735221077527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective: More people with cystic fibrosis (pwCF) are reaching adulthood and considering their reproductive futures. Unfortunately, many pwCF report gaps in their reproductive healthcare. We describe measures of stakeholder engagement in developing a reproductive goals decision aid for women with CF called MyVoice:CF. Methods: Stakeholders reviewed the content, design, and usability of the tool, which was informed by prior research related to CF family planning experiences and preferences as well as a conceptual understanding of reproductive decision making. We evaluated stakeholder engagement via process measures and outcomes of stakeholder involvement. We collected data via recorded stakeholder recommendations and surveys. Results: Fourteen stakeholders participated and the majority described their role on the project as "collaborator", "advisor", or "expert." Most felt their expectations for the project were met or exceeded, that they had contributed significantly, and that they received sufficient and frequent information about the process. All stakeholders provided recommen-dations and clarified aims for a CF-specific family planning tool, including its content and focus on facilitating shared decision making. Discussion: Utilizing meaningful stakeholder contributions, we developed MyVoice:CF, a novel web-based decision aid to help women with CF engage in shared decision-making regarding their reproductive goals. Practical Value: Our findings from working with stakeholders for MyVoice:CF indicate that disease-specific reproductive health resources can and should be designed with input from individuals in the relevant communities.
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Affiliation(s)
- Olivia M. Stransky
- Center for Women's Health Research and Innovation, 230 McKee Place, Pittsburgh, PA 15213, USA
| | - Molly Pam
- Cystic Fibrosis Reproductive and Sexual Health Collaborative, Seattle, WA, USA
| | - Sigrid L. Ladores
- University of Alabama at Birmingham, School of Nursing, 1701 University Blvd, THT 422, Birmingham, AL 35294, USA
| | - Mehret Birru Talabi
- Center for Women's Health Research and Innovation, 230 McKee Place, Pittsburgh, PA 15213, USA
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Sonya Borrero
- Center for Women's Health Research and Innovation, 230 McKee Place, Pittsburgh, PA 15213, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA 15240, USA
| | - Emily M. Godfrey
- Department of Family Medicine, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Andrea H. Roe
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | | | - Lisa C. Zuckerwise
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 1161 21 Avenue South, B-1100 Medical Center North, Nashville, TN 37232, USA
| | - Sheila Mody
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego
| | - Laura Mentch
- Cystic Fibrosis Reproductive and Sexual Health Collaborative, Seattle, WA, USA
| | - Ashley Deal
- School of Design, Carnegie Mellon University, 5130 Margaret Morrison St, Pittsburgh, PA 15213, USA
| | - Raelynn O’Leary
- School of Design, Carnegie Mellon University, 5130 Margaret Morrison St, Pittsburgh, PA 15213, USA
| | - Jennifer L. Taylor-Cousar
- Divisions of Pulmonary, Critical Care and Sleep Medicine and Pediatric Pulmonary Medicine, National Jewish Health, 1400 Jackson Street, Denver, Colorado 80206, USA
| | - Raksha Jain
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Traci M. Kazmerski
- Center for Women's Health Research and Innovation, 230 McKee Place, Pittsburgh, PA 15213, USA
- Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University Center, 120 Lytton Ave., Mezzanine Floor Suite M060, Pittsburgh, PA, 15213, USA
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Cartwright AF, Alspaugh A, Britton LE, Noar SM. mHealth Interventions for Contraceptive Behavior Change in the United States: A Systematic Review. JOURNAL OF HEALTH COMMUNICATION 2022; 27:69-83. [PMID: 35255773 PMCID: PMC9133092 DOI: 10.1080/10810730.2022.2044413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Ensuring people have access to their preferred method of contraception can be key for meeting their reproductive goals. A growing number of mHealth interventions show promise for improving access to contraception, but no literature review has identified the effects of mHealth interventions among both adolescents and adults in the United States. The purpose of this systematic review was to describe the format, theoretical basis, and impact of mHealth interventions for contraceptive behavior change (contraceptive initiation and continuation) among people of all ages in the US. A systematic review of the literature was conducted using six electronic databases guided by Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Data on study design, frequency, duration, mHealth modality, contraceptive method, behavior change theory, and behavioral outcome were extracted to facilitate comparison. Eighteen studies met eligibility criteria. The majority (11; 61%) used SMS (short message service). Twelve studies focused on contraceptive initiation, most (n = 8) of which also measured continued use over time. The remaining six interventions focused on continuation alone, generally through appointment reminders. Very little contraceptive behavior change was identified across studies. Current mHealth interventions may hold promise for some health areas but there is little evidence that they change contraceptive behavior. Future mHealth interventions should focus on assessing person-centered outcomes, including satisfaction, side effects, and reasons for discontinuation, to best support people to use their preferred contraceptive method.
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Affiliation(s)
- Alice F. Cartwright
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amy Alspaugh
- ACTIONS Program, University of California, San Francisco – School of Nursing, San Francisco, CA, USA
| | | | - Seth M. Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Silva RRD, Silva Filho JAD, Lima ERD, Belém JM, Pereira RDS, Oliveira CAND. Woman-centered shared decision-making to promote contraceptive counseling: an integrative review. Rev Bras Enferm 2022; 75:e20210104. [DOI: 10.1590/0034-7167-2021-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/30/2021] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To summarize scientific evidence on the woman-centered shared decision-making process for the promotion of contraceptive counseling. Methods: Integrative literature review with a sample of nine primary articles selected from MEDLINE via PubMed, CINAHL, Web of Science, Scopus, ScienceDirect, Embase, LILACS, and BDENF. Results: The study evidenced a comprehensive chain of segments for the development of the shared approach centered on women through counseling on contraception, fragmenting the evidence acquisition in relational elements for the choice implementation and continuation of the chosen method; systematization of consistent information for choice implementation and continuation of the method; and challenges for implementing shared decision-making. Final considerations: The process of woman shared decision-making centered during the consultation on contraception counseling favors the qualified choice and effective adherence to a contraceptive method based on the professional’s clinical vision adjusted to the woman’s preferences.
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Burke HM, Ridgeway K, Murray K, Mickler A, Thomas R, Williams K. Reproductive empowerment and contraceptive self-care: a systematic review. Sex Reprod Health Matters 2022; 29:2090057. [PMID: 35892261 PMCID: PMC9336472 DOI: 10.1080/26410397.2022.2090057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Holly M. Burke
- Scientist, FHI 360, Reproductive, Maternal, Newborn, and Child Health division, Durham, NC, USA. Correspondence:
| | - Kathleen Ridgeway
- Research Associate, FHI 360, Health Services Research division, Durham, NC, USA
| | - Kate Murray
- Research Associate, FHI 360, Reproductive, Maternal, Newborn, and Child Health division, Durham, NC, USA
| | - Alexandria Mickler
- Program Analyst, USAID/Public Health Institute, Office of Population and Reproductive Health, Washington, DC, USA
| | - Reana Thomas
- Technical Officer, FHI 360, Research Utilization division, Durham, NC, USA
| | - Katie Williams
- MPH Candidate, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Fellow, FHI 360, Durham, NC, USA
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Lerma K, McBrayer A, Nathan S, Dehlendorf C, White K. Use of a contraceptive decision support tool in the abortion care setting. Contraception 2022; 113:68-70. [DOI: 10.1016/j.contraception.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/03/2022]
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Danna K, Angel A, Kuznicki J, Lemoine L, Lerma K, Kalamar A. Leveraging the Client-Provider Interaction to Address Contraceptive Discontinuation: A Scoping Review of the Evidence That Links Them. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:948-963. [PMID: 34933989 PMCID: PMC8691884 DOI: 10.9745/ghsp-d-21-00235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/06/2021] [Indexed: 11/26/2022]
Abstract
Despite considerable investment and effort, unmet need for contraception remains an obstacle to improved family planning outcomes. One influencing factor is the frequency of contraceptive discontinuation among users who desire to prevent pregnancy, often due to method-related concerns and side effects. Contraceptive users have the right to be supported during counseling to voluntarily choose methods that align with their individual needs and preferences. Contraceptive counseling, as a key component of quality of care, is particularly important for providers to reduce unmet need among their clients. This scoping review examined the state of the evidence on contraceptive counseling and its impact on discontinuation. The review first examines the association between quality of care and contraceptive discontinuation, then looks to what the current body of evidence suggests are women's contraceptive counseling priorities, and lastly, explores whether specific counseling tools and approaches have been evaluated with discontinuation as an outcome. The results identified general principles and priorities for good counseling including person-centeredness, client-tailored information exchange, clear and concise information on side effects and bleeding changes, reducing providers' implicit and explicit biases, and trust and respect between the client and provider. The review of the literature also found that evidence to support the use of specific counseling tools and approaches to reduce contraceptive discontinuation is insufficient; research should be designed to determine which specific elements of the client-provider interaction can be improved to significantly impact contraceptive discontinuation. This evidence could inform how the global community of practice might improve and leverage specific counseling approaches and tools to address the most common predictors of discontinuation.
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Affiliation(s)
- Kendal Danna
- Population Services International, Washington, DC, USA.
| | | | | | | | - Klaira Lerma
- Stanford University, Stanford, CA, USA
- University of Texas at Austin, Austin, TX, USA
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Bailey JE, Gurgol C, Pan E, Njie S, Emmett S, Gatwood J, Gauthier L, Rosas LG, Kearney SM, Robler SK, Lawrence RH, Margolis KL, Osunkwo I, Wilfley D, Shah VO. Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review. J Med Internet Res 2021; 23:e28503. [PMID: 34878986 PMCID: PMC8693194 DOI: 10.2196/28503] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/04/2021] [Accepted: 10/03/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Health systems and providers across America are increasingly employing telehealth technologies to better serve medically underserved low-income, minority, and rural populations at the highest risk for health disparities. The Patient-Centered Outcomes Research Institute (PCORI) has invested US $386 million in comparative effectiveness research in telehealth, yet little is known about the key early lessons garnered from this research regarding the best practices in using telehealth to address disparities. OBJECTIVE This paper describes preliminary lessons from the body of research using study findings and case studies drawn from PCORI seminal patient-centered outcomes research (PCOR) initiatives. The primary purpose was to identify common barriers and facilitators to implementing telehealth technologies in populations at risk for disparities. METHODS A systematic scoping review of telehealth studies addressing disparities was performed. It was guided by the Arksey and O'Malley Scoping Review Framework and focused on PCORI's active portfolio of telehealth studies and key PCOR identified by study investigators. We drew on this broad literature using illustrative examples from early PCOR experience and published literature to assess barriers and facilitators to implementing telehealth in populations at risk for disparities, using the active implementation framework to extract data. Major themes regarding how telehealth interventions can overcome barriers to telehealth adoption and implementation were identified through this review using an iterative Delphi process to achieve consensus among the PCORI investigators participating in the study. RESULTS PCORI has funded 89 comparative effectiveness studies in telehealth, of which 41 assessed the use of telehealth to improve outcomes for populations at risk for health disparities. These 41 studies employed various overlapping modalities including mobile devices (29/41, 71%), web-based interventions (30/41, 73%), real-time videoconferencing (15/41, 37%), remote patient monitoring (8/41, 20%), and store-and-forward (ie, asynchronous electronic transmission) interventions (4/41, 10%). The studies targeted one or more of PCORI's priority populations, including racial and ethnic minorities (31/41, 41%), people living in rural areas, and those with low income/low socioeconomic status, low health literacy, or disabilities. Major themes identified across these studies included the importance of patient-centered design, cultural tailoring of telehealth solutions, delivering telehealth through trusted intermediaries, partnering with payers to expand telehealth reimbursement, and ensuring confidential sharing of private information. CONCLUSIONS Early PCOR evidence suggests that the most effective health system- and provider-level telehealth implementation solutions to address disparities employ patient-centered and culturally tailored telehealth solutions whose development is actively guided by the patients themselves to meet the needs of specific communities and populations. Further, this evidence shows that the best practices in telehealth implementation include delivery of telehealth through trusted intermediaries, close partnership with payers to facilitate reimbursement and sustainability, and safeguards to ensure patient-guided confidential sharing of personal health information.
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Affiliation(s)
- James E Bailey
- Tennessee Population Health Consortium, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Cathy Gurgol
- Patient-Centered Outcomes Research Institute, Washington, DC, United States
| | - Eric Pan
- Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States
| | - Shirilyn Njie
- Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States
| | - Susan Emmett
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Duke Global Health Institute, Durham, NC, United States
| | - Justin Gatwood
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Lynne Gauthier
- Department of Physical Therapy and Kinesiology, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, United States
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
- Department of Medicine, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
| | - Shannon M Kearney
- Solution Insights & Validation, Highmark Health, Pittsburgh, PA, United States
| | | | - Raymona H Lawrence
- Community Health Behavior and Education, Jiann-Ping College of Public Health, Georgia Southern University, Statesboro, GA, United States
| | | | - Ifeyinwa Osunkwo
- Cancer Care, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States
| | - Denise Wilfley
- Department of Psychiatry, College of Medicine, Washington University in St. Louis, St Louis, MO, United States
| | - Vallabh O Shah
- Department of Internal Medicine and Biochemistry, School of Medicine, University of New Mexico, Albuquerque, NM, United States
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Jull J, Köpke S, Smith M, Carley M, Finderup J, Rahn AC, Boland L, Dunn S, Dwyer AA, Kasper J, Kienlin SM, Légaré F, Lewis KB, Lyddiatt A, Rutherford C, Zhao J, Rader T, Graham ID, Stacey D. Decision coaching for people making healthcare decisions. Cochrane Database Syst Rev 2021; 11:CD013385. [PMID: 34749427 PMCID: PMC8575556 DOI: 10.1002/14651858.cd013385.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Decision coaching is non-directive support delivered by a healthcare provider to help patients prepare to actively participate in making a health decision. 'Healthcare providers' are considered to be all people who are engaged in actions whose primary intent is to protect and improve health (e.g. nurses, doctors, pharmacists, social workers, health support workers such as peer health workers). Little is known about the effectiveness of decision coaching. OBJECTIVES To determine the effects of decision coaching (I) for people facing healthcare decisions for themselves or a family member (P) compared to (C) usual care or evidence-based intervention only, on outcomes (O) related to preparation for decision making, decisional needs and potential adverse effects. SEARCH METHODS We searched the Cochrane Library (Wiley), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), CINAHL (Ebsco), Nursing and Allied Health Source (ProQuest), and Web of Science from database inception to June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) where the intervention was provided to adults or children preparing to make a treatment or screening healthcare decision for themselves or a family member. Decision coaching was defined as: a) delivered individually by a healthcare provider who is trained or using a protocol; and b) providing non-directive support and preparing an adult or child to participate in a healthcare decision. Comparisons included usual care or an alternate intervention. There were no language restrictions. DATA COLLECTION AND ANALYSIS Two authors independently screened citations, assessed risk of bias, and extracted data on characteristics of the intervention(s) and outcomes. Any disagreements were resolved by discussion to reach consensus. We used the standardised mean difference (SMD) with 95% confidence intervals (CI) as the measures of treatment effect and, where possible, synthesised results using a random-effects model. If more than one study measured the same outcome using different tools, we used a random-effects model to calculate the standardised mean difference (SMD) and 95% CI. We presented outcomes in summary of findings tables and applied GRADE methods to rate the certainty of the evidence. MAIN RESULTS Out of 12,984 citations screened, we included 28 studies of decision coaching interventions alone or in combination with evidence-based information, involving 5509 adult participants (aged 18 to 85 years; 64% female, 52% white, 33% African-American/Black; 68% post-secondary education). The studies evaluated decision coaching used for a range of healthcare decisions (e.g. treatment decisions for cancer, menopause, mental illness, advancing kidney disease; screening decisions for cancer, genetic testing). Four of the 28 studies included three comparator arms. For decision coaching compared with usual care (n = 4 studies), we are uncertain if decision coaching compared with usual care improves any outcomes (i.e. preparation for decision making, decision self-confidence, knowledge, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching compared with evidence-based information only (n = 4 studies), there is low certainty-evidence that participants exposed to decision coaching may have little or no change in knowledge (SMD -0.23, 95% CI: -0.50 to 0.04; 3 studies, 406 participants). There is low certainty-evidence that participants exposed to decision coaching may have little or no change in anxiety, compared with evidence-based information. We are uncertain if decision coaching compared with evidence-based information improves other outcomes (i.e. decision self-confidence, feeling uninformed) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with usual care (n = 17 studies), there is low certainty-evidence that participants may have improved knowledge (SMD 9.3, 95% CI: 6.6 to 12.1; 5 studies, 1073 participants). We are uncertain if decision coaching plus evidence-based information compared with usual care improves other outcomes (i.e. preparation for decision making, decision self-confidence, feeling uninformed, unclear values, feeling unsupported, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with evidence-based information only (n = 7 studies), we are uncertain if decision coaching plus evidence-based information compared with evidence-based information only improves any outcomes (i.e. feeling uninformed, unclear values, feeling unsupported, knowledge, anxiety) as the certainty of the evidence was very low. AUTHORS' CONCLUSIONS Decision coaching may improve participants' knowledge when used with evidence-based information. Our findings do not indicate any significant adverse effects (e.g. decision regret, anxiety) with the use of decision coaching. It is not possible to establish strong conclusions for other outcomes. It is unclear if decision coaching always needs to be paired with evidence-informed information. Further research is needed to establish the effectiveness of decision coaching for a broader range of outcomes.
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Affiliation(s)
- Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Meg Carley
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark
| | - Anne C Rahn
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lubeck, Lubeck, Germany
| | - Laura Boland
- Integrated Knowledge Translation Research Network, The Ottawa Hospital Research Institute, Ottawa, Canada
- Western University, London, Canada
| | - Sandra Dunn
- BORN Ontario, CHEO Research Institute, School of Nursing, University of Ottawa, Ottawa, Canada
| | - Andrew A Dwyer
- William F. Connell School of Nursing, Boston University, Chestnut Hill, Massachusetts, USA
- Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jürgen Kasper
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Simone Maria Kienlin
- Faculty of Health Sciences, Department of Health and Caring Sciences, University of Tromsø, Tromsø, Norway
- The South-Eastern Norway Regional Health Authority, Department of Medicine and Healthcare, Hamar, Norway
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Canada
| | - Krystina B Lewis
- School of Nursing, University of Ottawa, Ottawa, Canada
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
| | | | - Claudia Rutherford
- School of Psychology, Quality of Life Office, University of Sydney, Camperdown, Australia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
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Callegari LS, Nelson KM, Arterburn DE, Dehlendorf C, Magnusson SL, Benson SK, Schwarz EB, Borrero S. Development and Pilot Testing of a Patient-Centered Web-Based Reproductive Decision Support Tool for Primary Care. J Gen Intern Med 2021; 36:2989-2999. [PMID: 33538956 PMCID: PMC8481447 DOI: 10.1007/s11606-020-06506-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient-centered counseling to help women achieve their reproductive goals is an essential yet often absent component of primary care. OBJECTIVE We developed and piloted MyPath, a novel web-based decision support tool integrating reproductive goals assessment, information about optimizing health before pregnancy, and contraceptive decision support, for use prior to primary care visits in the Veterans Administration (VA). DESIGN We created MyPath using best practices for decision tool development, including a conceptual framework informed by theory and user-centered design with input from patients, providers, and scientific experts. We conducted a non-randomized pilot in two VA Women's Health primary care clinics. A control group (n = 28) was recruited prior to and intervention group (n = 30) recruited after introduction of MyPath into clinics. PARTICIPANTS Women Veterans ages 18-44 with an upcoming visit scheduled with one of eight providers. INTERVENTIONS After recruitment of controls, providers and staff received a brief introduction to MyPath. Patients scheduled to see providers in the intervention phase used MyPath on an iPad in the waiting room prior to their visit. MAIN MEASURES Acceptability, feasibility, discussions about pregnancy and/or contraceptive needs, and contraceptive decision quality by a survey of participants and providers. KEY RESULTS Nearly all participants who used MyPath reported they learned new information (97%) and would recommend it to other Veterans (93%). No providers reported that MyPath significantly increased workload. A greater proportion of intervention participants reported having discussions about reproductive needs in their visit compared to controls (93% vs 68%; p = 0.02). Intervention participants also experienced greater increases in pre-/post-visit knowledge and communication self-efficacy and a trend towards greater reduction in contraceptive decision conflict compared to controls. CONCLUSIONS MyPath was highly acceptable to women, increased the proportion of primary care visits addressing reproductive needs, and improved decision quality without increasing providers' perceived workload. A larger randomized evaluation of effectiveness is warranted.
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Affiliation(s)
- Lisa S Callegari
- Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
- Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, WA, USA.
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA.
| | - Karin M Nelson
- Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Christine Dehlendorf
- Department of Family Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sara L Magnusson
- Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
| | - Samantha K Benson
- Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
| | - E Bimla Schwarz
- Department of Medicine, University of California, Davis, Davis, CA, USA
| | - Sonya Borrero
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Bitzer J, Oppelt PG, Deten A. Evaluation of a patient-centred, needs-based approach to support shared decision making in contraceptive counselling: the COCO study. EUR J CONTRACEP REPR 2021; 26:326-333. [PMID: 33871288 DOI: 10.1080/13625187.2021.1908539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The Contraceptive Counselling (COCO) study tested whether a structured approach to assessing patient needs and expectations improved method choice and satisfaction with the contraceptive decision-making process. METHODS Physicians and women were invited to complete needs-based contraceptive counselling sessions using a structured questionnaire. Physicians recorded the individual responses online; women evaluated the process using an immediate post-consultation questionnaire and then via a structured online interview 6 months later. RESULTS A total of 92 gynaecologists and 1176 women participated: 951 women completed the immediate post-consultation survey and 145 took part in the 6 month online evaluation. There was a substantial increase in satisfaction with the current contraceptive method: the number of women reporting they were 'very satisfied' with their contraceptive method increased by 30%. This applied to starters and switchers as well as to women continuing with their previous method. Women were highly satisfied with the structured approach; 95% rated the counselling as 'good' or 'very good' and 'comprehensive and detailed'. CONCLUSION Using a structured approach to share information tailored to women's needs can help them choose from a broader range of methods and, in some cases, change to a method more suitable to their individual needs, and ultimately increase satisfaction with their choice.
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Affiliation(s)
- J Bitzer
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
| | - P G Oppelt
- Department of Gynaecology, Erlangen University Hospital, University of Erlangen-Nuremberg, Erlangen, Germany
| | - A Deten
- Jenapharm GmbH & Co. KG, Jena, Germany
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Perceptions of a Spanish language Reproductive Health Self-assessment Tool Among Spanish-Speaking Women at a Federally Qualified Health Center. J Immigr Minor Health 2021; 22:691-700. [PMID: 32072377 DOI: 10.1007/s10903-020-00988-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Latinas face barriers to contraceptive and preconception care. Using a Reproductive Health Self-Assessment Tool (RH-SAT) before primary care visits may help overcome these barriers. Twenty Spanish-speaking women at a Federally Qualified Health Center in Chicago received the RH-SAT before their visit then completed a phone interview about their perceptions of the RH-SAT. Transcripts were thematically analyzed using a modified grounded theoretical approach. All participants self-reported Hispanic/Latina ethnicity, either of Mexican (N = 19) or Puerto Rican (N = 1) origin. Participants (1) believed the RH-SAT was easy to use and its content was useful for women with a variety of reproductive goals; (2) felt it provided new information about preparing for pregnancy and contraception; (3) were prompted by the RH-SAT to self-reflect and ask questions not previously considered; and (4) felt it could help overcome barriers some women experience in discussing reproductive health. Participants felt the RH-SAT provided new information and would prompt them to discuss contraception and/or preparing for pregnancy with their clinician. This tool has the potential to facilitate patient-clinician discussion of reproductive health in primary care and overcome barriers experienced by some Spanish-speaking women.
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Acceptability and feasibility of the CHARISMA counseling intervention to support women's use of pre-exposure prophylaxis: results of a pilot study. BMC WOMENS HEALTH 2021; 21:126. [PMID: 33766006 PMCID: PMC7992829 DOI: 10.1186/s12905-021-01262-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/11/2021] [Indexed: 12/31/2022]
Abstract
Background Women may need or seek male partner approval to safely and consistently use oral antiretroviral pre-exposure prophylaxis (PrEP) or vaginal microbicides. We developed CHARISMA, a counseling intervention to support women’s relationships and their ability to consistently use HIV prevention products. Methods In a pilot study with 95 female participants in Johannesburg, South Africa, lay counselors implemented CHARISMA, assessing participants’ relationship(s) with their male partner(s) and barriers or facilitators to HIV prevention method use, and then providing tailored, interactive counseling. We conducted study participant surveys and clinic staff interviews to evaluate CHARISMA’s feasibility and acceptability. Results The CHARISMA pilot study indicates that a two-session relationship counseling intervention with 6-month follow-up to support women’s ability to safely and effectively use vaginal microbicides was generally acceptable and feasible. Most participants thought CHARISMA was relevant, helpful, and about the right length, and that it had a positive impact on their relationships with their partners and their product use. Staff estimated that the intervention took 1.5–2 h to implement at enrollment and 45 min to an hour for the month 1 visit. They thought that overall CHARISMA was generally feasible to implement. Conclusions Findings from this study suggest several lessons learned that may be relevant to others developing interventions supporting women’s use of oral PrEP or vaginal microbicides. The use of lay counselors instead of nurses to deliver counseling appeared to be successful, but the counselors experienced significant stress from hearing about participants’ traumatic experiences and required emotional support to avoid burnout. Although staff and participants felt that having multiple intervention sessions over time was valuable, a similar level of intensity may not be feasible in other settings. Further research is needed to determine an intervention delivery mode and follow-up period that optimally balances participant needs and clinic resources. Male engagement was a challenge, as it has been in previous studies of vaginal microbicides. Alternative strategies to reach men that do not require them to come to the clinic or rely on their female partners may be more effective. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01262-z.
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Tebb KP, Rodriguez F, Pollack LM, Adams S, Rico R, Renteria R, Trieu SL, Hwang L, Brindis CD, Ozer E, Puffer M. Improving contraceptive use among Latina adolescents: A cluster-randomized controlled trial evaluating an mHealth application, Health-E You/Salud iTu. Contraception 2021; 104:246-253. [PMID: 33744300 DOI: 10.1016/j.contraception.2021.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of Health-E You/Salud iTu, a mobile health application (app), on increasing knowledge, self-efficacy and contraception use among Latina adolescents, its impact on visit quality, and app satisfaction. STUDY DESIGN This study used cluster-randomized controlled trial (CRCT) of 18 school-based health centers (SBHCs). Prior to the visit, intervention participants received the patient-centered contraceptive decision-making support app and controls answered sexual health questions on iPads. Participants completed a previsit questionnaire and 3 follow-up surveys (48 hours, 3-, and 6-months) after the recruitment visit (where intervention participants completed the app). Differences in adolescents' contraceptive knowledge, self-efficacy, and use over the 6-month follow-up were assessed by generalized mixed effects regression models. RESULTS A total of 1,360 Latina adolescents participated; 57.2% responded to the 48-hour survey, 50.1% to the 3-month, 49.7% to the 6-month, and 42.3% to both the 3- and 6-month surveys. Health-E You users' demonstrated significant increases in pre-post knowledge (p < 0.001). Intervention participants who completed the follow-up survey reported greater increases in mean self-efficacy from baseline (23.2 intervention vs. 22.5 controls) to 6 months (26.1 vs. 23.4; b = 1.58, 95% CI 0.38-2.77, p = 0.01), and greater increases in non-barrier contraceptive use from baseline (29% intervention vs. 30% controls) to 3 months (63% vs. 45%; OR = 3.29, 95% CI 1.04-10.36, p = 0.04) and 6 months (63% vs. 44%; OR = 5.54, 95% CI 1.70-18.06, p = 0.005). Providers and adolescents reported high app satisfaction and stated it improved visit quality. CONCLUSIONS While data suggest that Health-E You improved outcomes, findings must be interpreted cautiously. Intervention participants had higher baseline sexual activity rates, more recruitment visits for pregnancy testing, emergency contraception or birth control, and lower completion rates of follow-up surveys than controls. IMPLICATIONS Despite declines in adolescent pregnancy in the United States, Latinas continue to have disproportionately high rates compared to white females. The Health-E You app may be an effective support tool for both adolescents and providers in SBHCs, and possibly other clinical settings, across the country to increase contraceptive use and thereby decrease unintended pregnancies. It could potentially reduce disparities in adolescent pregnancies and create more efficient visit time spent between clients and their providers.
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Affiliation(s)
- Kathleen P Tebb
- Department of Pediatrics, University of California San Francisco, CA, USA.
| | - Felicia Rodriguez
- Department of Pediatrics, University of California San Francisco, CA, USA
| | - Lance M Pollack
- Center for AIDs Prevention Studies, University of California, San Francisco, CA, USA
| | - Sally Adams
- Department of Pediatrics, University of California San Francisco, CA, USA
| | - Rosario Rico
- The Los Angeles Trust for Children's Health, Los Angeles, CA, USA
| | - Robert Renteria
- The Los Angeles Trust for Children's Health, Los Angeles, CA, USA
| | - Sang Leng Trieu
- The Los Angeles Trust for Children's Health, Los Angeles, CA, USA
| | - Loris Hwang
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Claire D Brindis
- Department of Pediatrics and the Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth Ozer
- Department of Pediatrics and the Office for Diversity and Outreach, University of California San Francisco, San Francisco, CA, USA
| | - Maryjane Puffer
- The Los Angeles Trust for Children's Health, Los Angeles, CA, USA
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Sewell WC, Solleveld P, Seidman D, Dehlendorf C, Marcus JL, Krakower DS. Patient-Led Decision-Making for HIV Preexposure Prophylaxis. Curr HIV/AIDS Rep 2021; 18:48-56. [PMID: 33417201 PMCID: PMC8086908 DOI: 10.1007/s11904-020-00535-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Shared decision-making is a process that involves bidirectional exchange of information between patients and providers to support patients in making individualized, evidence-based decisions about their healthcare. We review the evidence on patient-led decision-making, a form of shared decision-making that maximizes patient autonomy, as a framework for decisions about HIV preexposure prophylaxis (PrEP). We also assess the likelihood that patient-led decision-making occurs for PrEP and describe interventions to facilitate this process. RECENT FINDINGS Patient-led decision-making is likely to be uncommon for PrEP, in part because healthcare providers lack knowledge and training about PrEP. Few evidence-based interventions exist to facilitate patient-led decision-making for PrEP. There is a need for rigorously developed interventions to increase knowledge of PrEP among patients and healthcare providers and support patient-led decision-making for PrEP, which will be increasingly important as the range of available PrEP modalities expands.
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Affiliation(s)
- Whitney C Sewell
- Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Dr, Ste 401, Boston, MA, 02215, USA
| | - Patricia Solleveld
- Beth Israel Deaconess Medical Center, Division of Infectious Diseases, 110 Francis St., W/LMOB Suite GB, Boston, MA, 02215, USA
| | - Dominika Seidman
- Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
- San Francisco General Hospital, 1001 Potrero Ave Ward 6D, San Francisco, CA, 94110, USA
| | - Christine Dehlendorf
- Family and Community Medicine, University of California, San Francisco, San Francisco General Hospital, 995 Potrero Avenue, Ward 83, San Francisco, CA, 94110, USA
| | - Julia L Marcus
- Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Dr, Ste 401, Boston, MA, 02215, USA
| | - Douglas S Krakower
- Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Dr, Ste 401, Boston, MA, 02215, USA.
- Beth Israel Deaconess Medical Center, Division of Infectious Diseases, 110 Francis St., W/LMOB Suite GB, Boston, MA, 02215, USA.
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Dehlendorf C, Fox E, Silverstein IA, Hoffman A, Campora Pérez MP, Holt K, Reed R, Hessler D. Development of the Person-Centered Contraceptive Counseling scale (PCCC), a short form of the Interpersonal Quality of Family Planning care scale. Contraception 2021; 103:310-315. [PMID: 33508252 DOI: 10.1016/j.contraception.2021.01.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Person-centeredness is a critical component of quality in family planning. We previously validated an 11-item Interpersonal Quality of Family Planning (IQFP) scale. We sought to create a parsimonious version of the scale in preparation for testing its appropriateness as a patient-reported outcome performance measure. STUDY DESIGN To explore clarity and importance of each of the 11 items, we conducted English and Spanish cognitive interviews with patients who received contraceptive counseling (n = 33) at 3 publicly funded California clinics. We triangulated these results with psychometric analysis of previously collected IQFP data (n = 1097) to assess validity and reliability of selected item combinations. RESULTS The 11-item IQFP scale was reduced to a 4-item scale (the Person-Centered Contraceptive Counseling scale, or PCCC) that includes items evaluating provider performance regarding respect for patients, information provision, and eliciting and honoring patient preferences for birth control. Interview participants deemed the items included in the 4-item PCCC important and clear in both English and Spanish versions of the instrument. The 4-item PCCC retained the 11-item IQFP's psychometric properties, including internal consistency (Cronbach's alpha = 0.92 vs 0.97 for the PCCC and IQFP, respectively) and a consistent single factor analysis solution (factor loadings = 0.86-0.92 and 0.81-0.91). The 4-item PCCC additionally retained the construct and predictive validity of the IQFP. CONCLUSIONS The 4-item PCCC is a valid and reliable as a measure of person-centered contraceptive counseling that reflects patients' perspectives on contraceptive counseling. IMPLICATIONS Person-centered measures such as the 4-item PCCC can help inform efforts to improve health care quality. Future work will investigate the validity and reliability of the 4-item PCCC as a performance measure to determine the appropriateness of its use in the quality improvement context.
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Affiliation(s)
- Christine Dehlendorf
- Department of Family & Community Medicine, University of California, San Francisco, CA, United States; Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, United States; Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, United States.
| | - Edith Fox
- Department of Family & Community Medicine, University of California, San Francisco, CA, United States
| | - Ilana A Silverstein
- Department of Family & Community Medicine, University of California, San Francisco, CA, United States
| | - Alexis Hoffman
- Department of Family & Community Medicine, University of California, San Francisco, CA, United States
| | - María Paula Campora Pérez
- Department of Family & Community Medicine, University of California, San Francisco, CA, United States
| | - Kelsey Holt
- Department of Family & Community Medicine, University of California, San Francisco, CA, United States
| | - Reiley Reed
- Department of Family & Community Medicine, University of California, San Francisco, CA, United States
| | - Danielle Hessler
- Department of Family & Community Medicine, University of California, San Francisco, CA, United States
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Evaluation of a computerized contraceptive decision aid: A randomized controlled trial. Contraception 2020; 102:339-345. [PMID: 32771369 DOI: 10.1016/j.contraception.2020.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a contraceptive decision aid in reducing decisional conflict among women seeking reversible contraception. STUDY DESIGN We conducted a randomized trial of a computer-based decision aid compared to a control group for women presenting for reversible contraception at two clinics affiliated with an academic medical center. The primary outcome was change in decisional conflict, measured before and after the healthcare visit using the validated Decisional Conflict Scale. We hypothesized the decision aid would reduce the decisional conflict score by 10 points on a 100-point scale (0 = no conflict, 100 = high conflict) compared to the control group. Secondary outcomes included contraceptive method chosen and satisfaction with the healthcare visit. RESULTS We enrolled and randomized 253 women, and 241 had complete data for our primary outcome. Overall, pre-visit decisional conflict scores were low, reflecting low levels of decisional conflict in our sample; median score 15 (range 0-80) in the decision aid and 10 (0-85) in the control group (p = 0.45). Both groups had a similar reduction in median decisional conflict after the healthcare visit: -10 (-80 to 25) and -10 (-60 to 5) in the decision aid and control groups respectively (p = 0.99). Choice of contraception (p = 0.23) and satisfaction with healthcare provider (p = 0.79) also did not differ by study group. CONCLUSIONS Decisional conflict around contraception was low in both groups at baseline. Use of a computerized contraceptive decision aid did not reduce decisional conflict, alter method choice, or impact satisfaction compared to the control group among women choosing reversible contraception. IMPLICATIONS Use of a computerized contraceptive decision aid did not reduce decisional conflict or alter method choice compared to the control group among women choosing reversible contraception. Future studies could focus on testing the decision aid in different clinical settings, especially where barriers to providing comprehensive contraceptive counseling exist.
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Buckingham P, Amos N, Saha SK, Hussainy SY, Mazza D. Contraception decision aids to improve care and effective method use. Hippokratia 2020. [DOI: 10.1002/14651858.cd013659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Natalie Amos
- General Practice; Monash University; Notting Hill Australia
| | | | | | - Danielle Mazza
- General Practice; Monash University; Notting Hill Australia
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Birth Control Connect: A randomized trial of an online group to disseminate contraceptive information. Contraception 2020; 101:376-383. [PMID: 32032641 DOI: 10.1016/j.contraception.2020.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/18/2019] [Accepted: 01/20/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We sought to test whether participation in an online group including IUD users influenced IUD-related knowledge, attitudes, and behavior among IUD non-users, as a proof-of-concept evaluation of information dissemination for less commonly used or novel contraceptives. STUDY DESIGN We conducted a blinded, randomized controlled trial on the effect of online communication with IUD users within an online program called Birth Control Connect. Participants were women age 18-45 living in the United States who had never used an IUD. We invited participants randomized to the intervention to join two-week, nine-member discussion groups including four satisfied IUD users and five IUD non-users; we invited control participants to groups including nine IUD non-users. We performed chi-squared tests on IUD knowledge, information-seeking, informational support and use in immediate post-surveys, and t-tests comparing change in IUD attitudes and frequency of logins to discussion groups. RESULTS We invited 488 IUD non-users and enrolled them into 70 groups between October 2015 and April 2016. We found increased positive attitudes towards the IUD in the intervention arm (0.65-point increase between pre- and post-surveys, versus 0.05 mean change for control arm, p = 0.03 for hormonal IUD, with a trend in the same direction for the non-hormonal IUD). Informational support also increased, with 70.3% of intervention arm participants self-reporting that they gained a better idea of what the IUD would be like, compared to 51.3% in control arm (p < 0.01). Of intervention participants, 63.3% versus 51.3% of control participants reported gaining new information from their group (p = 0.03). There were no differences in correct responses to knowledge items or information-seeking between groups. CONCLUSIONS Online exposure to IUD users increased positive attitudes toward the IUD and informational support for decision-making about the IUD among non-users. IMPLICATIONS STATEMENT Online spaces provide a promising environment for the exchange of accurate, useful contraceptive information based on real user experiences. Interventions aiming to harness social communication through structured online conversations (e.g., on existing social media platforms) about user experiences with lesser-known contraceptive methods such as the IUD may be worthwhile.
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Patient Decision Aids to Facilitate Shared Decision Making in Obstetrics and Gynecology. Obstet Gynecol 2020; 135:444-451. [DOI: 10.1097/aog.0000000000003664] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Holt K, Kimport K, Kuppermann M, Fitzpatrick J, Steinauer J, Dehlendorf C. Patient-provider communication before and after implementation of the contraceptive decision support tool My Birth Control. PATIENT EDUCATION AND COUNSELING 2020; 103:315-320. [PMID: 31537316 DOI: 10.1016/j.pec.2019.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/26/2019] [Accepted: 09/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare differences in patient-provider communication among patients who, prior to contraceptive counseling, used or did not use a decision support tool ("My Birth Control") which has educational and interactive modules and produces a provider printout with the patient's preferences. METHODS As part of a cluster-randomized trial of the tool in four San Francisco safety net clinics, we collected and thematically analyzed 70 audio recordings of counseling visits (31 pre- and 39 post-tool implementation) from 15 providers randomized to the intervention. RESULTS Without the tool, most providers began by asking participants what method they were considering and focused counseling on that method or on directing patients towards long-acting reversible contraception; with the tool, most focused on reviewing and discussing multiple methods of interest to the participant as indicated on the printout. Discussion of patients' preferences for specific method features was not observed in pre-implementation recordings but was part of several post-implementation recordings. Several participants explicitly noted they had gained knowledge from the tool. CONCLUSION Observed counseling differences suggest the tool may have a positive impact on patient-centeredness of contraceptive counseling, consistent with findings from the main study. PRACTICE IMPLICATIONS My Birth Control shows potential for improving patient-centeredness in counseling without extensive provider training.
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Affiliation(s)
- Kelsey Holt
- Department of Family & Community Medicine, University of California, San Francisco, USA.
| | - Katrina Kimport
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA.
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, USA.
| | - Judith Fitzpatrick
- Department of Family & Community Medicine, University of California, San Francisco, USA.
| | - Jody Steinauer
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA.
| | - Christine Dehlendorf
- Department of Family & Community Medicine, University of California, San Francisco, USA; Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, USA.
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Dehlendorf C, Reed R, Fitzpatrick J, Kuppermann M, Steinauer J, Kimport K. A mixed-methods study of provider perspectives on My Birth Control: a contraceptive decision support tool designed to facilitate shared decision making. Contraception 2019; 100:420-423. [DOI: 10.1016/j.contraception.2019.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/27/2019] [Accepted: 08/04/2019] [Indexed: 01/12/2023]
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The family planning quotient and reproductive life index (FPQ/RepLI) tool: a solution for family planning, reproductive life planning and contraception counseling. Reprod Health 2019; 16:125. [PMID: 31426800 PMCID: PMC6700782 DOI: 10.1186/s12978-019-0787-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/31/2019] [Indexed: 12/03/2022] Open
Abstract
Objective Access to comprehensive and culturally appropriate reproductive life planning is essential to women’s health. Although many strategies and tools exist, few are designed for longitudinal use or provide visual aids. Our objective is to present the Family Planning Quotient (FPQ) and Reproductive Life Index (RepLI) (FPQ/RepLI) tool we created to facilitate the discussion of family planning and reproductive life goals between patients and providers and to provide a summary our evaluation of the tool. This tool was developed as a response to the Centers for Disease Control and Prevention’s charge of developing a tool that could help facilitate reproductive life planning by giving the patient a better understanding of their reproductive goals and trajectory. Study design This cross-sectional evaluation of our tool took place with patients and providers at an urban, public hospital in Chicago. Patients spoke with a health educator about their sexual, gynecological, and obstetric history to complete the FPQ/RepLI tool. Our primary objective was to measure the proportion of women who indicated the tool was helpful and that they would use it to track their reproductive goals. Main outcome measures Patients and providers completed an evaluation survey rating their satisfaction with the tool. Survey responses were summarized using frequencies and percentages. Results During the study, 790 patients completed the evaluation.. Most patients (n = 725, 91.9%) agreed that the tool was helpful and that they would use it to track their reproductive goals. Fifty-five (83.5%) providers agreed that there is a need for reproductive health tools in clinical practice. Conclusions Most agreed that the tool helped the patient communicate goals, aided in educating about contraception, and facilitated the discussion and decision-making process about available contraceptives. The tool gives patients a resource for family and reproductive goal planning. Broad dissemination amongst other medical specialties beyond obstetrics and gynecology may make reproductive life planning accessible to more women.
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