Women's Preferred Sources for Primary and Mental Health Care: Implications for Reproductive Health Providers

Integrated Care for Persons With Persistent Gynecologic Conditions

Persons with persistent gynecologic conditions frequently cope with complex biopsychosocial challenges and benefit from integrated behavioral health evaluation and treatment within gynecologic practices. Integrated care refers to the provision of behavioral health services within a health care setting which contributes to improved patient, provider, and practice outcomes, however, has not been commonly provided in traditional gynecologic practices. Several models of integrated behavioral health are reviewed. Each model holds specific applications in primary and specialty gynecology settings and may enhance the gynecologic patient experience. This article reviews current research supporting integrated care and describes implementation, funding, and evaluation to improve patient outcomes.

Preexposure Prophylaxis Implementation in a Reproductive Health Setting: Perspectives From Planned Parenthood Providers and Leaders

Integrating pregnancy and HIV prevention services would make reproductive health care settings an optimal venue for the promotion and delivery of preexposure prophylaxis (PrEP) to cisgender women. However, these settings have been slow to adopt PrEP. Planned parenthood clinicians and leaders possess critical insight that can help accelerate PrEP implementation in reproductive health care settings and elements of the Consolidated Framework for Implementation Research (i.e., relative priority of the intervention to staff, implementation climate, available resources to implement the intervention, and staff access to knowledge and information about the intervention) can shed light on elements of Planned Parenthood's inner setting that can facilitate PrEP implementation. In this study, individual 60-min interviews were conducted with clinical care team members (n = 10), leadership team members (n = 6), and center managers (n = 2) to explore their perspectives on PrEP implementation and associated training needs. Transcripts were transcribed verbatim and thematically analyzed. Despite having variable PrEP knowledge, participants (100% women, 61% non-Hispanic White) expressed positive attitudes toward implementing PrEP. Barriers and facilitators toward providing PrEP were reported at the structural, provider, and patient levels. Participants desired PrEP training that incorporated culturally competent patient-provider communication. Although participants identified ways that Planned Parenthood uniquely enabled PrEP implementation, barriers must be overcome to optimize promotion and delivery of PrEP to cisgender women.

Women Veterans' Perspectives on Suicide Prevention in Reproductive Health Care Settings: An Acceptable, Desired, Unmet Opportunity

BACKGROUND

Women veterans of reproductive age experience a suicide rate more than double their civilian peers. Developing effective suicide prevention strategies for women veterans requires identifying settings frequented by women veterans where acceptable prevention initiatives can be implemented. Reproductive healthcare (RHC) settings may provide such an opportunity.

METHODS

We conducted semi-structured interviews with 21 cisgender women veterans of reproductive age using RHC services provided or paid for by the Department of Veterans Affairs (VA) to understand their beliefs, attitudes, and preferences regarding suicide risk assessment and prevention within these settings. Interview analysis was inductive and used a thematic analysis framework.

RESULTS

Four major themes emerged from the interviews: 1) positive patient-provider relationships in RHC settings are important; 2) some women veterans prefer women providers for RHC and suicide risk screening; 3) women veterans' experiences with VA suicide risk screening and assessment vary; and 4) suicide risk screening and prevention in RHC settings is a desired and acceptable, yet unmet opportunity.

CONCLUSIONS

Findings from this novel study suggest that VA RHC settings may present a viable milieu for implementing upstream, gender-sensitive, veteran-centric suicide prevention strategies. Future research is needed with VA RHC providers to determine their needs for successfully implementing such strategies.

Family Planning Providers' Assessment of Intimate Partner Violence and Substance Use

Background: Intimate partner violence (IPV) and substance use are intersecting health problems that adversely impact sexual and reproductive health outcomes for women seeking care at family planning (FP) clinics. We aimed to characterize whether and how FP clinic providers (1) assessed for IPV and substance use and (2) combined IPV and substance use assessments. Methods: Providers and patients (female, 18-29 years old, English speaking) at four FP clinics participating in a larger randomized controlled trial on provider communication skills were eligible. Providers received training on universal education, a research-informed IPV assessment approach. Visits were audio recorded, transcribed verbatim, and coded by two independent coders. We used inductive and deductive coding to assess providers' communication approaches and examined codes for patterns and categories. We then converted these approaches into variables to calculate frequencies among recorded visits. Results: Ninety-eight patient-provider encounters were analyzed. In almost all encounters (90/98), providers assessed for IPV. Many providers adopted best practice IPV assessment techniques, such as universal education (68/98) and normalizing/framing statements (45/98). Tobacco use screening was common (70/98), but alcohol (17/98) and other drug use screening (17/98) were rare. In only one encounter did a provider discuss IPV and substance use as intersecting health problems. Conclusion: This study provides insight on how FP clinicians, as key providers for millions of women in the United States, assess patients for IPV and substance use. Results show providers' willingness to adopt IPV universal education messaging and demonstrate room for improvement in substance use assessments and integrated discussions of IPV and substance use. Trial Registration Number: NCT01459458.

Improving Research, Policy, and Practice to Address Women's Sexual and Reproductive Health Care Needs During Emerging Adulthood

Women in the period of emerging adulthood (18-25 years of age) have the greatest rates of unintended pregnancy and sexually transmitted infections. Despite this disproportionate risk, women's sexual and reproductive health needs during emerging adulthood are poorly understood. As a result, few age-specific policies or person-centered practice guidelines are available to reduce sexual risk. In this commentary we explore the unique characteristics of emerging adulthood that contribute to greater sexual and reproductive health risks for women. Current evidence on sexual and reproductive health outcomes of women during emerging adulthood and limited practice guidelines are discussed. Recommendations for health care providers, especially nurses, for guiding personalized care for women in emerging adulthood are discussed.

Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Girls and Women

Females ages 12 and older are the fastest growing segment of alcohol consumers in the United States, with the past decade showing a 16% increase in alcohol use per 12-month period and a 58% increase in high-risk drinking (i.e., > 3 drinks in a day and/or > 7 drinks in a week) per 12-month period. The increase in alcohol use and risk drinking poses unique and serious consequences for women. Women have a more rapid progression to alcohol-related problems and alcohol use disorders (AUD) than men, and if pregnant, women can potentially expose the fetus to alcohol. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based, integrated public health approach used to identify and address risky alcohol use among women in a variety of health and social service settings. This article presents the current status of SBIRT among girls ages 12 and older, women of childbearing age, and older women. Screening instruments, brief interventions, and implementation issues specific to women of all ages are described. Through this review of the current literature, care providers can determine best practices for the prevention and treatment of risk drinking in women of all ages presenting in health care settings.

A Mixed-Methods Pilot Study of Perinatal Risk and Resilience During COVID-19

Introduction/Objectives: National guidelines underscore the need for improvement in the detection and treatment of mood disorders in the perinatal period. Exposure to disasters can amplify perinatal mood disorders and even have intergenerational impacts. The primary aim of this pilot study was to use mixed-methods to better understand the mental health and well-being effects of the coronavirus disease 2019 (COVID-19) pandemic, as well as sources of resilience, among women during the perinatal period. Methods: The study team used a simultaneous exploratory mixed-methods design to investigate the primary objective. Thirty-one pregnant and postpartum women participated in phone interviews and were invited to complete an online survey which included validated mental health and well-being measures. Results: Approximately 12% of the sample reported high depressive symptomatology and 60% reported moderate or severe anxiety. Forty percent of the sample reported being lonely. The primary themes related to stress were uncertainty surrounding perinatal care, exposure risk for both mother and baby, inconsistent messaging from information sources and lack of support networks. Participants identified various sources of resilience, including the use of virtual communication platforms, engaging in self-care behaviors (eg, adequate sleep, physical activity, and healthy eating), partner emotional support, being outdoors, gratitude, and adhering to structures and routines. Conclusions: Since the onset of COVID-19, many pregnant and postpartum women report struggling with stress, depression, and anxiety symptomatology. Findings from this pilot study begin to inform future intervention work to best support this highly vulnerable population.

Health Care Disparities Among U.S. Women of Reproductive Age by Level of Psychological Distress

Background: Reproductive-age women have a high rate of contact with the health care system for reproductive health care. Yet, beyond pregnancy, little is known about psychological distress and unmet health care needs among these women. We examined reasons for delayed medical care and types of foregone care by level of psychological distress. Materials and Methods: We used a nationally representative sample of U.S. women aged 18-49, from the 2015-2016 National Health Interview Survey. Using the K6 screening tool for nonspecific psychological distress, we examined differences in reasons for delayed care and types of care foregone due to cost by level of psychological distress (none, moderate psychological distress [MPD], and severe psychological distress [SPD]). Results: Overall, 20% of U.S. women aged 18-49 had MPD (16%) or SPD (4%), equating to nearly 13 million women of reproductive age living with psychological distress. Women with SPD or MPD are more likely to have delayed and foregone care. Notably, women with SPD have higher odds of needing but not receiving mental health care (adjusted odds ratios [AOR] = 12.4, 95% confidence interval [CI] 8.4-18.4), specialist care (AOR = 3.6, 95% CI 2.6-5.1), and follow-up care (AOR = 3.5, 95% CI 2.4-5.1) due to cost than women with no psychological distress. Cost is the greatest barrier to timely medical care for women with MPD and SPD. Conclusions: Women of reproductive age with psychological distress face considerable structural and cost-related barriers to accessing health care, which may be exacerbated by their psychological state. Despite recent policy advances such as the Affordable Care Act, additional efforts by policymakers and providers are crucial to address the needs of this population.