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Batek LM, Leblanc NM, Alio AP, Stein KF, McMahon JM. Facilitators and barriers to contraception access and use for Hispanic American adolescent women: An integrative literature review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003169. [PMID: 39052657 PMCID: PMC11271872 DOI: 10.1371/journal.pgph.0003169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/01/2024] [Indexed: 07/27/2024]
Abstract
STATEMENT OF THE PROBLEM Hispanic American adolescents experience high rates of pregnancy with profound consequences. Compared with White teens, Hispanic teens use contraception less frequently and often choose less effective forms of contraception. Access to contraception is a primary barrier to use which contributes to relatively high and disparate rates of pregnancy in Hispanic teens. This integrative review identifies facilitators and barriers of contraception access and use for Hispanic women, 13-17 years of age, living in the U.S. METHODOLOGY Following the Whittemore and Knafl (2005) methodology and PRISMA guidelines, peer reviewed studies were retrieved from PUBMED, CINAHL and EMBASE. The Mixed Methods Appraisal Tool was used to assess the study quality and thematic analysis was used to categorize barriers and facilitators. FINDINGS Of 131 studies retrieved, 16 met inclusion criteria. Individual, interpersonal and healthcare provider factors were identified as primary categories of barriers and facilitators with structural issues comprising an additional barrier category. Individual level barriers were disproportionately represented and further categorized into themes: beliefs/misconceptions, dislike of contraception, pregnancy risk perception, lack of knowledge, and lack of control. Barriers related to cultural and religious influences were identified in individual, interpersonal and structural levels. The most frequently reported facilitators were perceived parent comfort discussing sexual health and past experience of pregnancy. DISCUSSION Limitations in this review may stem from heterogeneity in the acculturation and geography of participants and analysis by a single reviewer. Implications include considering the range of information sources and the influence they have on risk perception and risk mitigation for this population. CONCLUSION & SIGNIFICANCE Adolescents describe many modifiable influences on contraception access and use. Misperceptions related to contraception, stemming from beliefs and perceptions, can be corrected through increased access to reliable sources of sex education, parental support, and direct access to nurses and healthcare providers. Awareness of these influences can inform further research and intervention development to address these health disparities.
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Affiliation(s)
- Lindsay M. Batek
- School of Nursing, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Natalie M. Leblanc
- School of Nursing, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Amina P. Alio
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Karen F. Stein
- School of Nursing, University of Rochester Medical Center, Rochester, New York, United States of America
| | - James M. McMahon
- School of Nursing, University of Rochester Medical Center, Rochester, New York, United States of America
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Caballero TM, Carvajal DN, Crockett AH, Wilkinson TA. Supporting Sexual and Reproductive Health for Immigrant Families Across the Lifespan. Acad Pediatr 2024; 24:19-24. [PMID: 38991797 DOI: 10.1016/j.acap.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 07/13/2024]
Abstract
The ability to exercise autonomy in achieving reproductive health goals necessitates access to contraceptive and reproductive health information and medical care. Finding trusted, comprehensive, consistent and affordable reproductive care is particularly challenging for immigrants living in the United States, especially for those without legal immigration status and for those who prefer a language other than English. In immigrant communities, sexual and reproductive health (SRH) knowledge, contraceptive choice, and family planning are influenced by many factors including tension between traditional and adopted cultural norms, limited English proficiency, restricted health care access, and structural racism. The family-centered model and longitudinal nature of relationships in pediatric primary care pose a unique opportunity to support immigrant families across the lifespan in obtaining SRH information and achieving reproductive health goals. Here, we present the unique vulnerabilities faced by immigrants seeking SRH services in the United States including both the upstream and downstream health effects of immigration status on family health. We then describe four time points across the lifespan where pediatricians can support SRH, including examples of existing SRH programming designed or adapted for immigrant families. Finally, we discuss opportunities to advance research, policy, education, and clinical care related to SRH equity for immigrant families.
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Affiliation(s)
- Tania M Caballero
- Division of General Pediatrics/Department of Pediatrics (TM Caballero), Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Diana N Carvajal
- Director of Reproductive Health Education in Family Medicine (RHEDI), Department of Family and Community Medicine (DN Carvajal), University of Maryland School of Medicine, Baltimore.
| | - Amy H Crockett
- Division of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology (AH Crockett), Prisma Health and the University of South Carolina School of Medicine, Greenville.
| | - Tracey A Wilkinson
- Department of Pediatrics/Children's Health Services Research (TA Wilkinson), Indiana University School of Medicine, Indianapolis, Ind.
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Batek LM, Leblanc NM, Alio AP, McMahon JM. Study protocol: Examining sexual and reproductive health literacy in Mexican American young women using a positive deviance approach. PLoS One 2024; 19:e0303974. [PMID: 38781153 PMCID: PMC11115210 DOI: 10.1371/journal.pone.0303974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
Health literacy is generally low in marginalized groups, leading to delays in accessing care, poor health outcomes, and health disparities. Yet, some individuals in these groups demonstrate higher health literacy and better health outcomes. These exceptional cases exemplify 'positive deviance' because they have found ways to be successful where others have not. Identifying the methods, practices, and resources that these individuals have used to gain health literacy and healthcare access may have generalized application to improve health literacy, access to care, and health outcomes. Using the Integrated Model of Health Literacy, the main objectives of this study are to (1) identify facilitators, barriers, and strategies to gain sexual and reproductive health literacy and healthcare access and (2) to explore each of the core domains of health literacy as they relate to successful access of sexual and reproductive healthcare services among individuals identified as positive deviants. For the purposes of this mixed methods community engaged study, positive deviants are defined as Mexican American young women aged 18-29 years old living in Rural Western New York who have accessed sexual and reproductive healthcare within the past year. A community advisory committee will be formed to provide community-engaged guidance and support for the recruitment of participants. Positive deviants will participate in a survey and semi-structured interview. Data collection and analysis will be simultaneous and iterative. Results will provide evidence of positive deviant methods, practices, and strategies to gain health literacy and access to sexual and reproductive healthcare. Findings may reveal characteristics and patterns in the relationship of health literacy and healthcare access that can inform interventions to improve health literacy and make healthcare more accessible for this demographic group and context.
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Affiliation(s)
- Lindsay M. Batek
- School of Nursing, University of Rochester, Rochester, NY, United States of America
| | - Natalie M. Leblanc
- School of Nursing, University of Rochester, Rochester, NY, United States of America
| | - Amina P. Alio
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - James M. McMahon
- School of Nursing, University of Rochester, Rochester, NY, United States of America
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Schlegel EC, Pickler RH, Tate JA, Williams KP, Smith LH. The EMeRGE theory of emerging adult-aged women's sexual and reproductive health self-management: A grounded theory study. J Adv Nurs 2024; 80:510-525. [PMID: 37533185 PMCID: PMC10834842 DOI: 10.1111/jan.15814] [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: 08/05/2022] [Revised: 06/26/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023]
Abstract
AIMS To explore how emerging adult-aged women self-manage their sexual and reproductive health and to generate a grounded theory of these self-management processes. DESIGN Grounded theory methods using a constructivist approach. METHODS Between September 2019 and September 2020, 18- to 25-years-old women (n = 13) were recruited from a 4-year university, a 2-year community college, and neighbourhoods surrounding the institutions of higher education. Individual interviews were transcribed verbatim and qualitatively analysed using a constant comparative method and inductive coding. RESULTS The theory purports that core processes of sexual and reproductive health self-management used by the women in this study included both passive and (re)active processes. These processes expanded upon and/or maintained the women's accessible sexual and reproductive health knowledge, behaviour and beliefs, defined as the sexual and reproductive health repertoire. The processes appeared to be cyclical and were often initiated by a catalysing event or catalyst and resulted in conversations with confidantes, or trusted individuals. A catalyst was either resolved or normalized by expanding or maintaining the sexual and reproductive health repertoire. CONCLUSION The resulting theory, EMeRGE Theory, offers insight into the complex and cyclical processes emerging adult-aged women use to simultaneously develop and adapt their foundational sexual and reproductive health knowledge, behaviours and beliefs. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE This explication of emerging adult-aged women's sexual and reproductive health self-management processes can be used by nurses and nurse researchers to better address this population's unique health needs. IMPACT The EMeRGE Theory provides valuable guidance for future exploratory and intervention research aimed at improving the health and well-being of emerging adult-aged women. REPORTING METHOD The authors adhered to the Consolidated Criteria for Reporting Qualitative studies (COREQ) in preparation of this publication. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Emma C Schlegel
- Center for Nursing Research, Scholarship and Innovation, College of Nursing, Michigan State University, East Lansing, Michigan, USA
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Rita H Pickler
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Judith A Tate
- Center for Aging, Self-Management and Complex Care, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Karen Patricia Williams
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Laureen H Smith
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, 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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Mitchell A, Gutmann-Gonzalez A, Brindis CD, Decker MJ. Contraceptive access experiences and perspectives of Mexican-origin youth: a binational qualitative study. Sex Reprod Health Matters 2023; 31:2216527. [PMID: 37335382 DOI: 10.1080/26410397.2023.2216527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Access to comprehensive contraceptive services for youth is essential to improving sexual and reproductive health. However, youth in many countries still face substantial obstacles to contraceptive access and use. The purpose of this study is to compare the contraceptive access experiences and perspectives of pregnant and parenting Mexican-origin youth in Guanajuato, Mexico, and Fresno County, California. Focus groups and in-depth interviews were conducted in Spanish and English among female youth in Mexico (n = 49) and California (n = 25). Participants also completed a brief sociodemographic survey. Using a modified grounded theory approach, qualitative data were coded and thematically analysed based on Penchansky and Thomas's Theory of Access, and results were compared by location. Although knowledge of a service provider was high among youth in both locations, access was affected by social, cultural, and institutional dynamics and contraceptive use was mixed. Across locations, participants described obstacles to accessing their preferred method. Participants worried about parental and peer opinions about their use of contraception (acceptability), and about perceived side effects including infertility and pain (adequacy). Contextual differences included lack of contraceptive choice in Guanajuato (availability) and incomplete knowledge about options in Fresno County (awareness). The power to request and receive their method of choice (agency) emerged as an important dimension that was not part of the original theory. Latina youth living in Mexico and the United States face multiple challenges accessing needed contraceptive options and services. Recognising and reducing these barriers can strengthen the contraceptive care landscape and promote the reproductive health and agency of young people. DOI: 10.1080/26410397.2023.2216527Plain language summary: Although sexually active youth need access to comprehensive sexual and reproductive health services, youth in many countries face substantial barriers to care. This study compares the experiences of pregnant and parenting youth in accessing contraceptive services in Mexico and the United States. We conducted interviews and focus groups with 74 Mexican-origin young women and found that contraceptive use and access was affected by their concerns about parental and peer opinions as well as by provider attitudes. In Mexico, several participants reported being denied their preferred method by their provider. Identifying and addressing barriers to services can improve the quality of care and the reproductive health of young people.
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Affiliation(s)
- Ashley Mitchell
- Graduate Student Researcher, Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Abigail Gutmann-Gonzalez
- Project Director, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Claire D Brindis
- Distinguished Professor, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Martha J Decker
- Associate Professor, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Hart L, Parsons G, Beaudoin J, Alonge O, Karp C. A Mixed Methods Study of Contraceptive Counseling and Care at a Federally Qualified Health Center in Maryland. J Patient Exp 2023; 10:23743735231183572. [PMID: 37362247 PMCID: PMC10286192 DOI: 10.1177/23743735231183572] [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] [Indexed: 06/28/2023] Open
Abstract
This study examined the experience of contraceptive counseling and care in a Federally Qualified Health Center in Maryland. Patients attending medical visits in 2021 were surveyed using the Interpersonal Quality of Family Planning scale to assess the quality of contraceptive counseling. Medical chart reviews were performed to identify alignment between contraceptive care received, and preferences patients had expressed. Primary care providers, reproductive health providers, and a subgroup of patients were interviewed to further contextualize survey and chart review findings. The average item score for the 94 survey participants was 4.39 (SD: 0.9) out of 5. Factor analysis showed high internal consistency reliability (alpha = 0.96). Eighty percent of patients received contraceptive care that aligned with their preferences, 4% did not, and 16% lacked clear contraceptive preferences. Qualitative analysis revealed that patients desired more guidance from providers in selecting a contraceptive method, while providers noted logistical and insurance-related barriers to care. While the quality of contraceptive counseling was high, patient experience of care may be improved by implementing team-based care.
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Affiliation(s)
- Leah Hart
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Chase Brexton Health Care, Baltimore, MD, USA
| | | | - Jarett Beaudoin
- Preventive Medicine Residency, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Olakunle Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Celia Karp
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Cooke-Jackson A, Rubinsky V, Gunning JN. "Wish I Would Have Known that before I Started Using It": Contraceptive Messages and Information Seeking among Young Women. HEALTH COMMUNICATION 2023; 38:834-843. [PMID: 34544296 DOI: 10.1080/10410236.2021.1980249] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In recent decades, women's use of contraception has evolved. Women not only utilize contraceptives to prevent pregnancy, but also to manage menstruation and other factors related to their personal agency. Despite an abundance of available contraceptive options, many women struggle to navigate and address their contraceptive needs. A hundred and thirty-four female participants responded to an open-ended questionnaire about contraceptive messages and decision making in an online survey. Using Uncertainty Management Theory as a framework, we illustrate how the women make sense of and manage uncertainty from multiple contraceptive messages. Results highlighted the absence of desired information, and identified messages that women wish they had received from healthcare providers and others. Our findings suggest that women's understanding of contraceptives' side effects is a communicative process in which anecdotal evidence is often treated as medical fact and healthcare providers are viewed as ineffective and dismissive in relaying and addressing information about contraception. In the absence of satisfying healthcare interactions, women seek information elsewhere to make their contraceptive choices.
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Carvajal DN, Bevilacqua KG, Caldwell MT, Zambrana RE. Provider perspectives on patient-centered contraceptive counseling for Latinas in Baltimore, MD. Contraception 2023; 119:109921. [PMID: 36535412 PMCID: PMC9957913 DOI: 10.1016/j.contraception.2022.109921] [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: 02/28/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To explore: 1) provider narratives of their contraceptive counseling practices with Latina patients within the context of patient-centered care (PCC); and 2) provider perceptions about the barriers to the provision of patient-centered contraceptive counseling in general and more specifically, with Latina patients in Baltimore, MD. STUDY DESIGN We conducted 25 semistructured qualitative interviews with physicians and nurse practitioners from four specialties who provide contraceptive care to Latinas in Baltimore, MD. We analyzed data using directed content analysis. We discuss findings with attention to major constructs of PCC, applying a reproductive justice framework. RESULTS Providers described a contraceptive counseling approach focused on pregnancy prevention as the primary goal. Most respondents used a tiered-effectiveness approach, even while noting the importance of PCC. Providers noted health system barriers to PCC, including time constraints and insurance status. Provider-reported patient-attributed barriers included low patient education/health literacy, culturally-attributed misconceptions about contraception, and language discordance. CONCLUSION Providers described knowledge of and intention to practice PCC but had limited integration of it in their own counseling with Latinas. Responses suggest tension between an expressed desire to provide PCC and paternalistic counseling paradigms that prioritize pregnancy prevention over patient preferences. Inequitable health system barriers also interfere with true implementation of contraceptive PCC. IMPLICATIONS Translating contraceptive PCC into practice, especially for marginalized communities, is paramount. Training should teach clinicians to recognize systems of structural inequity and discrimination that have informed approaches to counseling but are not reflective of PCC. Institutional policies must address health system barriers that also hamper PCC.
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Affiliation(s)
- Diana N Carvajal
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.
| | - Kristin G Bevilacqua
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Martina T Caldwell
- Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, United States
| | - Ruth E Zambrana
- Harriet Tubman Department of Women, Gender and Sexuality Studies, University of Maryland, College Park, MD, United States
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Non-barrier contraceptive use patterns among Latina adolescents attending California reproductive health centers: A longitudinal study. Contraception 2023; 118:109897. [PMID: 36240905 DOI: 10.1016/j.contraception.2022.09.135] [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: 01/18/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To describe use of non-barrier contraceptives over a 9-month period, consistency in method use, and identify factors associated with method nonuse, switching, and consistency among Latina adolescents attending California sexual and reproductive health (SRH) centers. STUDY DESIGN We conducted a cohort study using data self-reported at baseline, and 3- and 9-months post-baseline. The analysis included 1162 sexually active adolescents aged 18 to 19 who self-identified as female and Latina, indicated that they were not currently pregnant or trying to become pregnant, and who attended California SRH centers between June 2016 and June 2020. We used binomial generalized multivariable linear models with a log link to assess the likelihood of nonbarrier method consistency, switching, and non-use. RESULTS At baseline, 453 of 1162 (39%) of respondents were using short-acting methods (pill, patch, ring, or injection), 113 of 1162 (9.7%) were using long-acting methods (implants or intrauterine devices [IUDs]), and 596 of 1162 (51.3%) reported using neither short- nor long-acting methods. Over a 9-month period, 22/33 (66.7%) of those using IUDs consistently used the method, which was a statistically greater frequency of consistency than individuals who selected other nonbarrier methods (270/530 [50.9%], aRR: 1.40; 95% CI: 1.11, 1.77). Implant users had rates of method consistency similar to users of other nonbarrier methods (aRR: 1.11; 95% CI: 0.89, 1.38). Factors independently associated with method consistency included being older, having never been pregnant, having greater perceived risk of pregnancy, and greater contraceptive knowledge. CONCLUSION Sexually active Latina adolescents attending California SRH centers who were not trying to become pregnant maintained consistent contraceptive use more frequently when using an IUD. Using a patient-centered approach, contraceptive counseling for Latina adolescents can describe the combined efficacy and contraceptive stability offered by IUDs should patients desire it. IMPLICATIONS This study addressees gaps in knowledge about U.S. Latina adolescents' contraceptive use patterns. We demonstrate that IUD users, and not implant users, appear more likely to consistently use their method than those using non-LARC methods. Patient-centered contraceptive counseling for Latina adolescents can describe the greater contraceptive stability that IUDs may offer.
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Gerchow L, Squires A. Dimensional Analysis of Shared Decision Making in Contraceptive Counseling. J Obstet Gynecol Neonatal Nurs 2022; 51:388-401. [PMID: 35605641 DOI: 10.1016/j.jogn.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To conduct a dimensional analysis to identify conceptual gaps around shared decision making (SDM) in reproductive health care and to refine the conceptual definition of SDM as related to contraceptive counseling. DATA SOURCES We identified source data through systematic searches of the CINAHL and PubMed databases. STUDY SELECTION We included peer-reviewed research and nonresearch articles that addressed contraceptive counseling for pregnancy prevention in the United States. We did not consider date of publication as an inclusion criterion. We included 35 articles in the final review. DATA EXTRACTION Using dimensional analysis, we extracted data to clarify the definition of SDM as a socially constructed concept that varies by perspective and context. DATA SYNTHESIS Data synthesis enabled us to compare SDM from patient and provider perspectives and to identify four primary dimensions of SDM that varied by context: Patient Preferences, Relationship, Provider Bias, and Clinical Suitability. CONCLUSION The four dimensions we identified illustrate the complexity and depth of SDM in contraceptive counseling encounters and broaden the definition of SDM to more than an encounter in which decision making incorporates clinician expertise and patient participation. We identified several assumptions that indicate the need for improved understanding that SDM is not a universal concept across perspectives and contexts. Most researchers in the included articles addressed the Patient Preferences dimension. Fewer considered the patient-provider relationship, the effect of provider bias, and the effect of specific clinical circumstances on SDM. We propose a conceptual map and model that can be used to refine the concepts that inform SDM and guide providers and researchers. Future research is needed to address the remaining gaps.
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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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Cicerchia G, Reid LD, Carvajal DN. Contraceptive Decision-Making and the Importance of Side Effect Information Among a Sample of Latinas. WOMEN'S HEALTH REPORTS 2022; 3:78-84. [PMID: 35136879 PMCID: PMC8812509 DOI: 10.1089/whr.2021.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 11/13/2022]
Abstract
Context: U.S. Latinas have lower rates of contraceptive use and report more negative counseling experiences compared to non-Latina white women. Patient-centered approaches to contraceptive counseling are desired among Latinas and are also associated with patient satisfaction; yet, clinicians may not always use counseling methods that best support decision-making among marginalized groups. Objective: To examine Latinas' expectations of physician communication about contraceptive side effects, reported importance of personal knowledge about side effects, and the association of these with contraceptive use and use consistency. Materials and Methods: One hundred three self-identified Latinas aged 15–29 years at two urban federally qualified health centers completed a survey measuring factors associated with contraceptive use and consistency. Bivariate analysis was used to assess demographic and contraceptive information preferences. Associations between categorical variables were assessed using two-sided Fisher's exact tests. Continuous variables were compared using two-sided t-test. Results: The majority of respondents (85%) expected physicians to tell them about birth control side effects and reported that this information is important to use contraception, regardless of current contraceptive use. Among inconsistent and nonusers, importance of knowledge of side effects depended on expectations of information-sharing from physicians (p < 0.05). Conclusions: Expectations regarding side effect information-sharing by physicians and patient knowledge of side effects are important for the contraceptive decision-making process of this Latina group, regardless of contraceptive use. Clinicians engaging in contraceptive counseling should focus on providing clear and accurate information about side effects of discussed methods to facilitate informed decision-making and equitable, patient-centered contraceptive care for this vulnerable population.
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Affiliation(s)
- Gaia Cicerchia
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lawrence D. Reid
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Diana N. Carvajal
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Brault MA, Curry LA, Kershaw TS, Singh K, Vash-Margita A, Camenga DR. Supporting Patient-centered Communication on Adolescent Sexual and Reproductive Health-Perspectives to Build an Appointment Planning Tool. J Pediatr Adolesc Gynecol 2021; 34:725-731. [PMID: 33989800 PMCID: PMC10712738 DOI: 10.1016/j.jpag.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/02/2021] [Accepted: 04/25/2021] [Indexed: 12/25/2022]
Abstract
STUDY OBJECTIVE Input from adolescents and healthcare providers is needed to develop electronic tools that can support patient-centered sexual and reproductive (SRH) care. This study explores facilitators and barriers to patient-centered communication in the context of developing an electronic appointment planning tool to promote SRH communication in clinic settings. DESIGN In-depth interviews were conducted to explore what constitutes adolescent-friendly SRH care and communication, as well as on the design of the appointment planning tool. Interviews were coded iteratively, and analyzed using the software Atlas.TI v8. SETTING An adolescent primary care clinic, and a pediatric and adolescent gynecology clinic. PARTICIPANTS Adolescent girls (N=32; ages 14-18) and providers who care for adolescent girls (N=10). MAIN OUTCOME MEASURES Thematic analyses explored facilitators/barriers to SRH communication and care and preferences for the tool. RESULTS Facilitators identified by adolescents and providers included: direct patient/provider communication; adolescent-driven decision-making regarding care and contraceptive choice; supplementing clinic visits with electronic resources; and holistic care addressing physical, mental, and social needs. Barriers identified by participants included: limited time for appointments; limited adolescent autonomy in appointments; and poor continuity of care when adolescents cannot see the same provider. Given the complexity of issues raised, adolescents and providers were interested in developing an appointment planning tool to guide communication during appointments, and contributed input on its design. The resulting Appointment Planning Tool app pilot is in progress. CONCLUSIONS Qualitative interviews with adolescents and providers offer critical insights for the development and implementation of mobile health (mHealth) tools that can foster patient-centered care.
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Affiliation(s)
- Marie A Brault
- Department of Social and Behavioral Sciences, 60 College Street, PO Box 208034, Yale School of Public Health, New Haven, CT, 06520-8034, USA.
| | - Leslie A Curry
- Global Health Leadership Initiative, 100 Church Street South, Yale School of Public Health, New Haven, CT, 06519, USA; Department of Health Policy and Management, 60 College Street, PO Box 208034, Yale School of Public Health, New Haven, CT, 06520-8034, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, 60 College Street, PO Box 208034, Yale School of Public Health, New Haven, CT, 06520-8034, USA
| | - Karen Singh
- Department of Social and Behavioral Sciences, 60 College Street, PO Box 208034, Yale School of Public Health, New Haven, CT, 06520-8034, USA
| | - Alla Vash-Margita
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Farnham Memorial Building, Yale School of Medicine, New Haven, CT, 06520, USA
| | - Deepa R Camenga
- Department of Emergency Medicine, 464 Congress Avenue, Suite 260, Yale School of Medicine, New Haven, CT, 06519, USA
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Carvajal DN, Klyushnenkova E, Barnet B. Latina contraceptive decision-making and use: The importance of provider communication and shared decision-making for patient-centered care. PATIENT EDUCATION AND COUNSELING 2021; 104:2159-2164. [PMID: 33722428 PMCID: PMC8380658 DOI: 10.1016/j.pec.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Poor patient-provider communication, among other reasons, is a notable barrier to contraceptive decision-making among Latinas. Patient-centered approaches to contraceptive counseling that optimize communication align with shared decision-making (SDM) -which is associated with satisfaction and continued contraceptive use among various populations. OBJECTIVE To examine associations of patient-provider communication and importance of SDM tenets with consistent contraceptive use among a population of Latinas. PATIENT INVOLVEMENT Formative work for this study included prior qualitative and quantitative research with Latinas who expressed the importance of patient-provider communication during contraceptive counseling and therefore were instrumental in problem definition. METHODS Cross-sectional surveys were administered to Latinas ages 15-29 years. Patient-provider communication, patient-reported importance of specific SDM tenets, and consistent contraception use were measured and analyzed for associations. RESULTS 103 Latinas (mean age = 21.4) participated. 33% of participants<21 years were using contraception consistently vs. 67% for those ≥ 21 (p = 0.003). Among participants ≥ 21, consistent users reported higher communication scores compared to inconsistent users and non-users (p = 0.042). For participants< 21, consistent users were more likely than inconsistent users and non-users to report that 2 SDM tenets (discussion of contraceptive preferences and avoidance of race/ethnic-based judgement) are important (p = 0.052, 0.028, respectively). DISCUSSION Patient-provider communication was especially important for Latinas ≥ 21 while using an SDM approach during counseling was highly valued by those<21. Patient-centered approaches to contraceptive counseling provide opportunities to optimize healthcare delivery for this vulnerable population. PRACTICAL VALUE Results from this research demonstrate that patient-centered communication is highly valued by Latina study participants and is an important consideration in their contraceptive counseling. Clinicians should consider employing techniques such as SDM as they seek to provide patient-centered care during contraceptive counseling for this patient population.
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Affiliation(s)
- Diana N Carvajal
- Department of Family and Community Medicine, University of Maryland School of Medicine, 29 S. Paca St., Baltimore, MD, USA.
| | - Elena Klyushnenkova
- Department of Family and Community Medicine, University of Maryland School of Medicine School of Medicine, Baltimore, MD, USA.
| | - Beth Barnet
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
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Maheen H, Chalmers K, Khaw S, McMichael C. Sexual and reproductive health service utilisation of adolescents and young people from migrant and refugee backgrounds in high-income settings: a qualitative evidence synthesis (QES). Sex Health 2021; 18:283-293. [PMID: 34412768 DOI: 10.1071/sh20112] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/01/2021] [Indexed: 11/23/2022]
Abstract
Young people with migrant or refugee backgrounds from low- and middle-income countries settle in high-income countries and tend to underutilise sexual and reproductive health (SRH) services. This review aimed to explore perceptions and experiences of SRH services and the factors that shape their use among migrant youth. It focuses on qualitative studies that examine SRH service use among young migrants living in high-income countries. Seven peer-review databases and web-based grey literature were searched using pre-determined search criteria. The review includes 16 articles that met the inclusion criteria. The qualitative evidence synthesis (QES) method was used to synthesise findings. Thematic analysis resulted in five main themes and 11 sub-themes. Findings suggest that despite diversity of countries of origin and host countries, there were considerable similarities in their perceptions of and experiences with SRH services. Some young migrants reported experiences of discrimination by service providers. Cost of care was a deterrent to SRH service use in countries without universal healthcare coverage. Lack of information about SRH services, concerns about confidentiality, community stigma around sexually transmitted infections and premarital sex were key barriers to SRH service use. Health systems should integrate flexible service delivery options to address access barriers of SRH service use in young migrants. Engagement with parents and communities can help to destigmatise sexual health problems, including STIs. Host countries need to equip young migrants with the knowledge required to make informed SRH decisions and access relevant SRH services and resources.
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Affiliation(s)
- Humaira Maheen
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia; and Corresponding author.
| | - Kate Chalmers
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia
| | - Sarah Khaw
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia
| | - Celia McMichael
- School of Geography Faculty of Science, University of Melbourne, 203 Bouverie Street, Carlton, Vic. 3053, Australia
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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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18
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Schlegel EC, Smith LH. Improving Research, Policy, and Practice to Address Women's Sexual and Reproductive Health Care Needs During Emerging Adulthood. Nurs Womens Health 2021; 25:10-20. [PMID: 33453156 PMCID: PMC8549865 DOI: 10.1016/j.nwh.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/11/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022]
Abstract
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.
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Meier S, Sundstrom B, Delay C, DeMaria AL. "Nobody's Ever Told Me That:" Women's Experiences with Shared Decision-making when Accessing Contraception. HEALTH COMMUNICATION 2021; 36:179-187. [PMID: 31556323 DOI: 10.1080/10410236.2019.1669271] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Half of all pregnancies in the United States are unintended. Contraceptive methods are effective in reducing unintended pregnancy burden. The shared decision-making model serves as best practice when choosing among healthcare options, and may be appropriate when considering contraceptive options. This study examined women's experiences with shared decision-making in contraceptive use dynamics. Researchers analyzed 38 interviews with women of reproductive age (range: 19-50 years) living in South Carolina (May-November 2016). Researchers completed a constant comparative method of data analysis using HyperRESEARCH 3.7.3 to explore reproductive-aged women's contraceptive decision-making. Shared decision-making provided a conceptual framework for analysis. Gaps in contraceptive knowledge, especially method effectiveness, impacted participants' experiences with contraception. Although participants believed they had adequate information, findings suggest they may not be fully informed about existing contraceptive options. Participants wanted options; however, results indicated women may not be actively involved in choosing contraception. Nuanced beliefs about contraception demonstrated preferences for patient-provider communication within the broader context of reproductive health and individual lifestyle needs. Findings from this study offer theoretical and practical recommendations to guide shared decision-making during contraceptive consultations to empower women in making informed and lifestyle-appropriate contraceptive choices.
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Affiliation(s)
- Stephanie Meier
- Department of Consumer Science, College of Health and Human Sciences, Purdue University
| | | | - Cara Delay
- Department of History, College of Charleston
| | - Andrea L DeMaria
- Department of Public Health, College of Health and Human Sciences, Purdue University
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20
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Arcara J, Arteaga S, Burny I, Gómez AM. Changes in expectation of relationship permanence, pregnancy acceptability and desire, and contraceptive use over time among young Latino/a women and men: An exploratory analysis. Contraception 2021; 103:19-25. [PMID: 33038304 PMCID: PMC7736367 DOI: 10.1016/j.contraception.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We longitudinally assess associations between changes in expectation of relationship permanence-a measure that incorporates both relationship duration and commitment-pregnancy desire and acceptability, and highly effective contraception use among young U.S. Latino/as. STUDY DESIGN We used multivariable logistic regression to analyze associations between changes in relationship factors, pregnancy acceptability and desire, and contraceptive method use over 6 months among 299 U.S. Latino/a women and men (ages 18-34) in relationships in a longitudinal study (retention rate: 32.4%). RESULTS Respondents who found a pregnancy less acceptable at endline than at baseline were more likely to use highly effective contraception at endline (OR 2.97, 95% CI 1.09, 8.08). Respondents estimating an increase in relationship permanence more than one standard deviation of the mean were 4.90 (95% CI 1.17, 20.55) times more likely to use highly effective contraception at endline, compared to those without a change in estimation of relationship permanence. CONCLUSION In this longitudinal study of young adult Latino/as in relationships, we found associations between changes in respondents' perceptions of the acceptability of a pregnancy and expectation of the permanence of their relationship and highly effective contraceptive use. Our findings reiterate the complicated, intertwined links between relationship dynamics, pregnancy orientation, contraception, and time. IMPLICATIONS The significance of decreased pregnancy acceptability (but not desire) for using highly effective contraception suggests the importance of acknowledging pregnancy acceptability in contraceptive counseling, particularly because providers are more likely to direct Latino/a young adults towards methods that may not fulfill their contraceptive desires. Including discussion of young people's expectations of relationship permanence may also be meaningful in counseling.
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Affiliation(s)
- Jennet Arcara
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
| | - Stephanie Arteaga
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
| | - Ilhaam Burny
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
| | - Anu Manchikanti Gómez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA.
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21
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Carvajal DN, Rivera Mudafort PC, Barnet B, Blank AE. Contraceptive Decision Making Among Latina Immigrants: Developing Theory-Based Survey Items. HISPANIC HEALTH CARE INTERNATIONAL 2020; 18:181-190. [PMID: 31646900 PMCID: PMC7180127 DOI: 10.1177/1540415319883422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contraception is important for reproductive autonomy, yet many Latinas do not use contraception consistently despite research reporting a desire to do so. Factors varying in priority and value come into play during contraceptive decision making. When measuring these, relevant survey items may vary by populations. AIM This study focused on developing an ethnically responsive, patient-centered, content-valid survey for measuring factors that influence contraceptive decision making among immigrant Latinas. METHOD Nonpregnant self-identified Latinas ages 15 to 24 years in Baltimore, MD, were recruited from a family planning facility. Using the theory of planned behavior as a theoretical framework and prior formative research, initial survey items were drafted (Step 1). Content validation and cognitive interviewing procedures (Step 2 and Step 3) were used to develop final items. RESULTS Final items (27) were content-validated by the target population; items reflect important factors and relevant contexts affecting contraceptive decision making among Latinas in Baltimore. DISCUSSION These theory-based items provide an important contribution to the literature because they measure and explore factors related to contraceptive decision making in an understudied population. Providers might consider these factors during counseling to build patient-centered communication. These items might serve to measure responses to theory of planned behavior-based interventions designed to improve the contraceptive counseling of Latinas.
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22
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Charron E, Mayo RM, Heavner-Sullivan SF, Eichelberger KY, Dickes L, Truong KD, Rennert L. “It’s a very nuanced discussion with every woman”: Health care providers’ communication practices during contraceptive counseling for patients with substance use disorders. Contraception 2020; 102:349-355. [DOI: 10.1016/j.contraception.2020.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 09/01/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
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23
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Walker S, Piercy H, Shearn K, Acton F. What consultation resources are available to support delivery of integrated sexual and reproductive health services? A scoping review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 46:88-99. [PMID: 31678969 DOI: 10.1136/bmjsrh-2019-200414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Contraceptive and sexual healthcare is increasingly delivered in an integrated setting in the UK and worldwide, requiring staff to be competent in differing styles of delivery, and to have a wide knowledge base. OBJECTIVES We did a scoping review of the literature for evidence of the resources that exist for healthcare professionals to guide or structure the process of conducting an integrated sexual and reproductive health (SRH) consultation. ELIGIBILITY CRITERIA Articles were included in the review if (1) their primary focus was a consultation resource related to one or more aspects of an SRH consultation and (2) they provided details of the resource and/or its application including evaluation of use. SOURCES OF EVIDENCE Peer-reviewed articles published in English, published non-peer-reviewed guides, and web-based guidelines addressing the conduct of a contraception or sexual health consultation were included. Date range: 1998-December 2018. Searches were carried out in the databases AMED (Ovid), ASSIA (ProQuest), CINAHL Complete (EBSCO), Cochrane Library (Wiley), HMIC (NHS Evidence), Medline (EBSCO), PsycINFO (Proquest) and Scopus (Elsevier) on 10 February 2017, and incremental searching performed until December 2018. RESULTS A total of 12 peer-reviewed journal articles, two web-published guidelines from the Faculty of Sexual & Reproductive Healthcare and three published, non-peer-reviewed resources were included. CONCLUSION Many resources exist to guide either the contraceptive or sexual health consultations, but there is a lack of a comprehensive consultation resource to guide the conduct of an integrated consultation.
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Affiliation(s)
- Susan Walker
- Faculty of Health, Education, Medicine & Social Care, Anglia Ruskin University, Chelmsford, UK
| | - Hilary Piercy
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Katie Shearn
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Faye Acton
- Faculty of Health, Education, Medicine & Social Care, Anglia Ruskin University, Chelmsford, UK
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24
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Arriens C, Aberle T, Carthen F, Kamp S, Thanou A, Chakravarty E, James JA, Merrill JT, Ogunsanya ME. Lupus patient decisions about clinical trial participation: a qualitative evaluation of perceptions, facilitators and barriers. Lupus Sci Med 2020; 7:e000360. [PMID: 32201595 PMCID: PMC7073780 DOI: 10.1136/lupus-2019-000360] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/18/2019] [Accepted: 01/05/2020] [Indexed: 01/11/2023]
Abstract
Objective Although SLE disproportionately affects minority racial groups, they are significantly under-represented in clinical trials in the USA. This may lead to misleading conclusions in race-based subgroup analyses. We conducted focus groups to evaluate the perceptions of diverse patients with lupus about clinical trial participation. Methods A qualitative research design employed three 90 min focus groups led by a trained moderator and guided by the Theory of Planned Behaviour. Open-ended questions about trial participation included advantages and disadvantages (behavioural beliefs), approving and disapproving significant others (normative beliefs), and participation enhancers and barriers (control beliefs). Discussions were recorded, transcribed and analysed to identify emerging themes. Results Patients with SLE (n=23) aged 21-72, with increased proportion of minority groups (65%), participated. Reported advantages of trial participation included altruism and personal benefit. Disadvantages included uncertainties, disappointment, information burden, and life-health balance. Although some patients had discussed research participation with approving or disapproving family or friends, self-approval superseded external approval. Barriers included logistics and time, and facilitators included flexibility in scheduling, advance notice of studies, streamlined forms, and hope for SLE improvement. Conclusions Knowledge about potential benefits of clinical trial participation was high. Minority patients demonstrated confidence in making their own informed decisions, but major barriers for all participants included burdensome forms, travel, childcare, and work. These suggest a major impact on minority and all recruitment from behavioural and control aspects, which should be considered in the logistics of trial design. This does not minimise the potential importance of improved access and education about clinical research.
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Affiliation(s)
- Cristina Arriens
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.,Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Teresa Aberle
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Fredonna Carthen
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Stan Kamp
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Aikaterini Thanou
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Eliza Chakravarty
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.,Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Judith A James
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.,Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Joan T Merrill
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Motolani E Ogunsanya
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Carvajal DN, Zambrana RE. Challenging Stereotypes: A Counter-Narrative of the Contraceptive Experiences of Low-Income Latinas. Health Equity 2020; 4:10-16. [PMID: 32154491 PMCID: PMC7058990 DOI: 10.1089/heq.2019.0107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose: Reproductive autonomy is associated with educational attainment, advanced employment, and well-being. While U.S. Latinas use contraception to control their own childbearing and have reported a desire to do so, they often use it inconsistently and have the lowest rates of contraceptive use of any group. Reasons previously cited for why Latinas do not use contraception compared with non-Latino white women include lack of access, lack of knowledge, language barriers, emphasis on large families, machismo, and religiosity. These reasons are often overly simplistic and can lead to widespread generalizations about Latinas. Methods: Using focus groups and semistructured interviews from November 2014 through June 2015, this study describes the family planning perspectives and experiences of 16 Latinas living in Baltimore and recruited from two federally qualified health centers. A social determinant of health framework was used to guide identification of important concepts and explain findings. Results: Results demonstrated that respondents reported contraceptive agency and claimed autonomy over their bodies; described a sense of responsibility and often expressed caution about having families too large to care for; expressed educational and career aspirations; and perceived contraception as critical for the postponement of childbearing to achieve their goals. Conclusion: The patient/provider encounter should include communication that recognizes all patient preferences and lived experiences to support vulnerable and/or marginalized Latinas in their desires to control their own childbearing and life choices.
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Affiliation(s)
- Diana N. Carvajal
- Department of Family & Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ruth Enid Zambrana
- Department of Women's Studies, University of Maryland, College Park, Maryland
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26
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Lynch M, Peinado S, Treiman K, McDaniel C, Vinci A, Creek E. Information needs across the family planning continuum: A survey of women with chronic autoimmune inflammatory conditions. PATIENT EDUCATION AND COUNSELING 2020; 103:103-111. [PMID: 31444093 DOI: 10.1016/j.pec.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/30/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study assessed the information needs of women with chronic autoimmune inflammatory conditions across the pregnancy continuum. METHODS We conducted a web-based survey with women about information needs related to family planning. Eligible participants were female, aged 18-44, had a diagnosis of a chronic inflammatory condition, and were at one of three pregnancy stages (planning, currently pregnant, or postpartum). RESULTS The survey yielded 209 responses. Respondents had high levels of information needs and were active information seekers. Many respondents reported difficulty finding the information they need. Over half (56.9%) reported receiving conflicting information from different doctors, and a majority of those respondents reported doing their own research. Respondents expressed the greatest interest in resources that facilitated connections to other women and their experiences (87.4%). Pregnancy stage was significantly associated with information needs and preferences; respondents in the planning stage of pregnancy had higher information needs, reported more dissatisfaction with communication with doctors, and were less connected to pregnancy resources. PRACTICE IMPLICATIONS Both providers and health/advocacy organizations have a role in improving information around this topic, such as developing and disseminating resources tailored to pregnancy status and supporting patient-centered communication around family planning.
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Affiliation(s)
- Molly Lynch
- RTI International, Research Triangle Park, NC, USA.
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27
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Sznajder K, Carvajal DN, Sufrin C. Patient perceptions of immediate postpartum long-acting reversible contraception: A qualitative study. Contraception 2020; 101:21-25. [PMID: 31655067 PMCID: PMC7137099 DOI: 10.1016/j.contraception.2019.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objective of this study was to explore perceptions and experiences of immediate postpartum long-acting reversible contraception (LARC) counseling and decision-making, with a focus on reproductive autonomy. We aimed to assess the potential for reproductive coercion. STUDY DESIGN This was a qualitative study using semi-structured interviews with Spanish and English speaking women who received an intrauterine device or contraceptive subdermal implant immediately postpartum. They were recruited before discharge from two hospitals in Baltimore, MD. We analyzed interviews using directed content analysis. RESULTS We interviewed a diverse group of 17 women. Participants praised the convenience of LARC and the ease of immediate postpartum placement. Some women reported feeling pushed by providers during counseling and were critical of their experiences. Women expressed a desire for comprehensive, objective information early and often during antepartum contraceptive counseling, and some valued counseling from multiple providers. They wanted autonomy in their contraceptive decision-making and described making internally motivated decisions based on their life goals and individual priorities. CONCLUSIONS Some women felt pressured to choose immediate postpartum LARC, while others expressed enthusiasm for immediate postpartum LARC. Our data suggest that providers should start contraceptive counseling early in prenatal care and readdress it at multiple visits. Patients may benefit from speaking with multiple providers. IMPLICATIONS Our study supports immediate postpartum LARC as a favorable contraceptive option for some women when discussed during prenatal care. Providers should take care to avoid coercion during counseling and focus on delivering comprehensive, objective information about all contraceptive methods, including side effects and removal options.
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Affiliation(s)
- Katharine Sznajder
- Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Hospital, 4940 Eastern Ave, Rm A121, Baltimore 21224, MD, USA
| | - Diana N Carvajal
- Department of Family & Community Medicine, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore 21201, Maryland, USA
| | - Carolyn Sufrin
- Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Hospital, 4940 Eastern Ave, Rm A121, Baltimore 21224, MD, USA.
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"If You Don't Ask, I'm Not Going to Tell You": Using Community-Based Participatory Research to Inform Pregnancy Intention Screening Processes for Black and Latina Women in Primary Care. Womens Health Issues 2019; 30:25-34. [PMID: 31562052 DOI: 10.1016/j.whi.2019.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/22/2019] [Accepted: 08/07/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Public health and medical professional organizations recommend screening women of reproductive age for pregnancy intention (PI) routinely in primary care. Existing PI screening tools may not address the complexity of intentions for women of color or lower socioeconomic status or be well-suited to primary care settings. This study sought to inform recommendations for carrying out PI screening meaningfully in primary care settings. METHODS This community-based participatory research project united staff from a research institution, community health organization, and federally qualified health center in a predominantly Latina community in New York City. The Community Advisory Board members designed the research question, developed qualitative interview guides, and conducted in-depth interviews with 30 English- and Spanish-speaking female federally qualified health center patients ages 15 to 49. Community Advisory Board members developed an initial codebook using an inductive approach and refined themes throughout the coding process. After coding, Community Advisory Board members created a conceptual map representing relationships between key themes, and generated data-informed recommendations for PI screening practices that are relevant and feasible in the community context. RESULTS Participants expressed a range of experiences with PI screening processes, depending on medical histories, attitudes, norms, and perceived benefits of screening. Three central themes emerged through frequency of occurrence, consistency in content, and relevance as reflected in concept mapping: agency, judgment and shame, and expertise versus authority. Recommendations included specific strategies and wording providers could use to explain the rationale and context for discussing PI. CONCLUSIONS Future work should examine the experience and effectiveness of implementing these community-based participatory research-derived recommendations in primary care.
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Cowen L, Hartman SG, Loomis E, Srinivasan S, Gasbarro C, Young J. Clinician and Staff Perceptions of Barriers to Providing Contraception in Primary Care. PRIMER : PEER-REVIEW REPORTS IN MEDICAL EDUCATION RESEARCH 2019; 3:2. [PMID: 32537573 DOI: 10.22454/primer.2019.228141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction Short interpregnancy periods increase the likelihood of preterm delivery and low birth weight,1 both of which are significant causes of infant morbidity and mortality.2 Since nearly half of pregnancies in the United States are unplanned,3 opportunities exist to better understand barriers to contraceptive services. Studying these barriers as perceived by clinical staff can better guide programs to improve interpregnancy spacing. Methods Between September and November 2017, 76 staff and 95 primary care clinicians from two family medicine residency practices (Highland Family Medicine (HFM) in Rochester, New York and St Margaret Family Medicine (SM) in Pittsburgh, Pennsylvania) completed surveys. Questions assessed perceived barriers to providing contraceptive services, contraception knowledge, and opportunities for improvement. Survey-based analysis focused on comparative descriptive statistics between staff and provider responses. Results Clinicians ranked side effects and patient lack of awareness and misconceptions about contraceptive methods more highly than staff (P=0.0073 and P=0.0001, respectively). Staff identified childcare and work absence as more significant barriers (P=0.0114 and P=0.0380, respectively). Providers felt appointment timing was the largest constraint to contraceptive care. Staff perceived financial limitations and scheduling to be the top barriers. Nonclinician staff exhibited significant knowledge gaps regarding contraception. Conclusions Numerous modifiable barriers contribute to difficulty providing contraceptive services. Providers and staff largely agree on the perceived barriers, but there is a significant gap in nonclinician staff knowledge of contraception. Education can address one of the leading concerns, but improvement efforts should also address areas such as availability of devices, scheduling issues, and resident supervision.
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Affiliation(s)
- Lauren Cowen
- University of Rochester Family Medicine Residency, Rochester, NY
| | | | - Elizabeth Loomis
- University of Rochester Family Medicine Residency, Rochester, NY
| | - Sukanya Srinivasan
- University of Pittsburgh Medical Center St Margaret Family Medicine Residency, Pittsburgh, PA
| | - Christina Gasbarro
- University of Pittsburgh Medical Center St Margaret Family Medicine Residency, Pittsburgh, PA
| | - Jocelyn Young
- University of Rochester Family Medicine Residency, Rochester, NY
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Duncan R, Paterson H, Anderson L, Pickering N. ‘We're kidding ourselves if we say that contraception is accessible’: a qualitative study of general practitioners’ attitudes towards adolescents’ use of long-acting reversible contraceptives (LARC). J Prim Health Care 2019; 11:138-145. [DOI: 10.1071/hc18105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 05/29/2019] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTIONAdolescents’ uptake of long-acting reversible contraceptives (LARCs) in New Zealand is low. We created the concept of a proactive LARC provision programme to overcome barriers to LARC uptake. Previously, this concept was discussed with adolescents and positively received. Lack of provider awareness is a barrier to LARC use identified in previous research and by adolescents.
AIMWe sought the views of general practitioners (GPs) to gauge whether LARCs and their proactive promotion for use in adolescents may be acceptable to GPs.
METHODSNine New Zealand GPs were interviewed about their contraception provision to adolescents and were then asked to comment on the concept of a proactive LARC provision programme. The data collected were transcribed and analysed using a general inductive approach to identify common themes and ideas. We concurrently interviewed and analysed interviews and continued to recruit GPs until thematic saturation was reached.
RESULTSSix themes were identified from the interviews: (1) contraceptive decision making; (2) the GP role; (3) sexual activity; (4) social context; (5) gauging adolescent understanding; and (6) youth. When we proposed the concept of a proactive LARC provision programme, the GPs responded positively.
DISCUSSIONThe research demonstrates that LARC uptake is affected by limited provider awareness. These findings align with other research internationally that identifies barriers to adolescent contraceptive use. The findings of this study suggest that other GPs may support a proactive LARC provision programme in New Zealand.
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Fox E, Reyna A, Malcolm NM, Rosmarin RB, Zapata LB, Frederiksen BN, Moskosky SB, Dehlendorf C. Client Preferences for Contraceptive Counseling: A Systematic Review. Am J Prev Med 2018; 55:691-702. [PMID: 30342632 PMCID: PMC6655529 DOI: 10.1016/j.amepre.2018.06.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 03/27/2018] [Accepted: 06/04/2018] [Indexed: 12/15/2022]
Abstract
CONTEXT Providers can help clients achieve their personal reproductive goals by providing high-quality, client-centered contraceptive counseling. Given the individualized nature of contraceptive decision making, provider attention to clients' preferences for counseling interactions can enhance client centeredness. The objective of this systematic review was to summarize the evidence on what preferences clients have for the contraceptive counseling they receive. EVIDENCE ACQUISITION This systematic review is part of an update to a prior review series to inform contraceptive counseling in clinical settings. Sixteen electronic bibliographic databases were searched for studies related to client preferences for contraceptive counseling published in the U.S. or similar settings from March 2011 through November 2016. Because studies on client preferences were not included in the prior review series, a limited search was conducted for earlier research published from October 1992 through February 2011. EVIDENCE SYNTHESIS In total, 26 articles met inclusion criteria, including 17 from the search of literature published March 2011 or later and nine from the search of literature from October 1992 through February 2011. Nineteen articles included results about client preferences for information received during counseling, 13 articles included results about preferences for the decision-making process, 13 articles included results about preferences for the relationship between providers and clients, and 11 articles included results about preferences for the context in which contraceptive counseling is delivered. CONCLUSIONS Evidence from the mostly small, qualitative studies included in this review describes preferences for the contraceptive counseling interaction. Provider attention to these preferences may improve the quality of family planning care; future research is needed to explore interventions designed to meet preferences. THEME INFORMATION This article is part of a theme issue entitled Updating the Systematic Reviews Used to Develop the U.S. Recommendations for Providing Quality Family Planning Services, which is sponsored by the Office of Population Affairs, U.S. Department of Health and Human Services.
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Affiliation(s)
- Edith Fox
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California.
| | - Arlene Reyna
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | | | | | - Lauren B Zapata
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Susan B Moskosky
- Office of Population Affairs, HHS, Washington, District of Columbia
| | - Christine Dehlendorf
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California,San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
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Arteaga S, Caton L, Gomez AM. Planned, unplanned and in-between: the meaning and context of pregnancy planning for young people. Contraception 2018; 99:16-21. [PMID: 30120926 DOI: 10.1016/j.contraception.2018.08.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To understand how young people conceptualize planned, unplanned and "in-between" pregnancies. METHODS We conducted individual qualitative interviews with 50 young (ages 18-24) women and their male partners (n=100) in the San Francisco Bay Area to investigate prospective pregnancy intentions. In this analysis, we focused on participants' conceptualization of planned and unplanned pregnancies, as well as a status in between planned and unplanned. RESULTS Conceptualizations of pregnancy planning were influenced by personal experiences and life circumstances, including previous unplanned pregnancies. While many participants held up planned pregnancies as an ideal, the majority of participants (n=71) also felt that a status in between planned and unplanned pregnancy existed. Many described this in-between stage occurring when someone is "not not trying" or would find an unplanned pregnancy acceptable. Notably, a few participants mentioned that pregnancy planning was not possible because either it was uncommon among their peers or they felt a general lack of control over pregnancy. CONCLUSION Our analysis suggests that binary operationalization of pregnancies as "planned" and "unplanned" neglects the complexity of young people's lived experiences and perspectives. Contraceptive counseling approaches that allow patients the flexibility to express their considerations and feelings toward a potential future pregnancy could improve the quality of family planning visits and patient-provider interactions. IMPLICATIONS The traditional binary conceptualization of pregnancies as planned and unplanned may not holistically capture the diverse perspectives of young people. Increased understanding of the complexities in young people's conceptualizion of pregnancy planning can inform family planning care that is inclusive, relevant and supportive of a variety of perspectives.
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Affiliation(s)
- Stephanie Arteaga
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
| | - Lauren Caton
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA.
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Hawkey AJ, Ussher JM, Perz J. “If You Don’t Have a Baby, You Can’t Be in Our Culture”: Migrant and Refugee Women’s Experiences and Constructions of Fertility and Fertility Control. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23293691.2018.1463728] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Alexandra J. Hawkey
- Translational Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Jane M. Ussher
- Translational Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Janette Perz
- Translational Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia
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Oakley LP, Harvey SM, López-Cevallos DF. Racial and Ethnic Discrimination, Medical Mistrust, and Satisfaction with Birth Control Services among Young Adult Latinas. Womens Health Issues 2018; 28:313-320. [PMID: 29729838 DOI: 10.1016/j.whi.2018.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/23/2018] [Accepted: 03/27/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Racial/ethnic discrimination and medical mistrust contribute to disparities in use of and satisfaction with health care services. Previous work examining the influence of discrimination and medical mistrust on health care experiences has focused primarily on African Americans. Despite the finding that Latinas report lower rates of contraceptive use than White women, little is known about the influence of these factors on health care satisfaction, specifically satisfaction with contraceptive services, among Latina women. METHODS We conducted computer-assisted interviews with 254 Latina women aged 18 to 25 living in rural communities in Oregon. Only the 211 women who reported ever receiving birth control services answered the question regarding satisfaction with birth control services and were included in the analytic sample. Using multivariable logistic regression models, we explored the relationship between medical mistrust and everyday discrimination on satisfaction with birth control services, accounting for relevant factors. RESULTS More than 80% of the total sample reported ever seeing a health care provider for birth control services and of these women, 75% reported being very or extremely satisfied with their birth control services. Latinas who reported higher levels of medical mistrust and racial/ethnic discrimination reported being less satisfied with birth control services. After adjusting for perceived barriers to accessing contraceptive services and other relevant factors, only perceived barriers and racial/ethnic discrimination remained significantly associated with satisfaction. CONCLUSIONS This study contributes to the growing understanding of the pervasive effects that racial/ethnic discrimination and medical mistrust have on satisfaction with health services among Latinas in the United States.
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Affiliation(s)
- Lisa P Oakley
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon.
| | - S Marie Harvey
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
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Jamin CG, Häusler G, Lobo Abascal P, Fiala C, Lete Lasa LI, Nappi RE, Micheletti MC, Fernández-Dorado A, Pintiaux A, Chabbert-Buffet N. Development and conceptual validation of a questionnaire to help contraceptive choice: CHLOE (Contraception: HeLping for wOmen's choicE). EUR J CONTRACEP REPR 2017; 22:286-290. [PMID: 28877640 DOI: 10.1080/13625187.2017.1364719] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this research was to develop a questionnaire to facilitate choice of the most appropriate contraceptive method for individual women. METHODS A literature review was conducted to identify key aspects influencing contraceptive choice and inform development of a questionnaire for online completion. Questionnaire development was overseen by a steering committee consisting of eight gynaecologists from across Europe. The initial draft underwent conceptual validation through cognitive debriefing interviews with six native English-speaking women. A qualitative content analysis was conducted to accurately identify potential issues and areas for questionnaire improvement. A revised version of the questionnaire then underwent face-to-face and online evaluation by 115 international gynaecologists/obstetricians with expertise in contraception, prior to development of a final version. RESULTS The final conceptually validated Contraception: HeLping for wOmen's choicE (CHLOE) questionnaire takes ≤10 min to complete and includes three sections to elicit general information about the individual, the health conditions that might influence contraceptive choice, and the woman's needs and preferences that might influence contraceptive choice. The questionnaire captures the core aspects of personalisation, efficacy and safety, identified as key attributes influencing contraceptive choice, and consists of 24 closed-ended questions for online completion prior to a health care provider (HCP) consultation. The HCP receives a summary of the responses. CONCLUSION The CHLOE questionnaire has been developed to help women choose the contraception that best suits their needs and situation while optimising the HCP's time.
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Affiliation(s)
| | - Gunther Häusler
- b Department of Gynaecology and Gynaecological Oncology , Vienna General Hospital , Vienna , Austria
| | - Paloma Lobo Abascal
- c Department of Obstetrics and Gynaecology , Infanta Sofía University Hospital , Madrid , Spain
| | - Christian Fiala
- d Gynmed Ambulatorium , Vienna , Austria.,e Department of Women's and Children's Health , Karolinska Institute , Stockholm , Sweden
| | - Luis Ignacio Lete Lasa
- f Department of Obstetrics and Gynaecology , Araba University Hospital , Vitoria-Gasteiz , Spain
| | - Rossella Elena Nappi
- g Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences , University of Pavia , Pavia , Italy
| | | | | | - Axelle Pintiaux
- j Department of Obstetrics and Gynaecology , Erasmus Hospital, Free University of Brussels , Brussels , Belgium
| | - Natalie Chabbert-Buffet
- k Department of Obstetrics and Gynaecology , APHP Tenon Hospital, Pierre and Marie Curie University , Paris , France
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