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Wingo E, Dehlendorf C. Lack of pregnancy intention or interest in pregnancy prevention now? How best to screen for desire for contraceptive care. Contraception 2024; 135:110303. [PMID: 37806473 DOI: 10.1016/j.contraception.2023.110303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES To assess the relationship between pregnancy intention and current desire for pregnancy prevention. STUDY DESIGN Using data from two state population-based surveys, we compared One Key Question and current pregnancy prevention desire. RESULTS The majority with ambivalence toward pregnancy (54%) and some respondents who wanted to become pregnant in a year (30%) desired pregnancy prevention now. CONCLUSIONS One Key Question did not capture the current pregnancy prevention desires of a sizeable minority of respondents. IMPLICATIONS A pregnancy prevention-focused screening approach may be better suited to identify those in need of contraceptive services compared to pregnancy intention screening.
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Affiliation(s)
- Erin Wingo
- Person-Centered Reproductive Health Program, Department of Family and Community Medicine, UCSF, San Francisco, CA, United States.
| | - Christine Dehlendorf
- Person-Centered Reproductive Health Program, Department of Family and Community Medicine, UCSF, San Francisco, CA, United States.
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2
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Wright RL, Kara D, Buchanan KC, Adler C, Pulley A. The Impact of Rural Environments on Reproductive Autonomy Among Women in Appalachia: A Qualitative Analysis. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2024; 36:273-286. [PMID: 39148922 PMCID: PMC11323869 DOI: 10.1080/19317611.2024.2360730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 08/17/2024]
Abstract
Reproductive autonomy encompasses one's ability to make decisions around contraceptive use, pregnancy, and childbirth. An individual's geographic location affects access to a wide range of information and care related to reproductive choice. Individuals in rural areas face additional barriers to reproductive health and decision-making than those in urban areas. This phenomenological qualitative study examined the experiences with and perceptions of reproductive decision-making among women in rural Appalachian communities in the United States. Four themes emerged from the data: autonomy tied to choice, role of religion and church on autonomy and decision-making, navigating limited access to care, and shame. Women should be supported in making reproductive health decisions, and efforts are needed to increase autonomy within reproductive health care and decisions. Sexual health programming within school and other community settings should address shame that often occurs around reproductive health topics, particularly among religious communities.
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Affiliation(s)
- Rachel L. Wright
- Department of Social Work, Appalachian State University, Boone, NC, USA
| | - Danyelle Kara
- Department of Social Work, Appalachian State University, Boone, NC, USA
| | - K. C. Buchanan
- Department of Social Work, Appalachian State University, Boone, NC, USA
| | - Cassie Adler
- Department of Social Work, Appalachian State University, Boone, NC, USA
| | - Amanda Pulley
- Department of Social Work, Appalachian State University, Boone, NC, USA
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Hale N, Lee J, de Jong J, Smith MG, Khoury AJ. Contraceptive Method Use Among a Population-Based Cohort During the South Carolina Choose Well Initiative. JAMA Netw Open 2024; 7:e248262. [PMID: 38656576 PMCID: PMC11043899 DOI: 10.1001/jamanetworkopen.2024.8262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/27/2024] [Indexed: 04/26/2024] Open
Abstract
Importance Evaluating the impact of statewide contraceptive access initiatives is necessary for informing health policy and practice. Objective To examine changes in contraceptive method use among a cohort of women of reproductive age in South Carolina during the Choose Well contraceptive access initiative. Design, Setting, and Participants In this cohort study, baseline data from the initial Statewide Survey of Women administered from October 1, 2017, to April 30, 2018, to a probability-based sample of women of reproductive age in South Carolina and a peer state (Alabama) were linked with 3 follow-up surveys given in 2019, 2020, and 2021. Responses about contraception use from the initial survey were compared with responses across follow-up surveys using the regression-based differences-in-differences method. Data analysis was performed from October 2023 to February 2024. Exposure The South Carolina Choose Well contraceptive access initiative seeks to fill contraceptive access gaps and increase provision of a full range of contraceptive methods through engagement with a wide range of health care organizations across the state. Main Outcomes and Measures Changes in contraceptive method use, including long-acting reversible contraception (LARC), intrauterine devices (IUDs), implants, short-acting hormonal injection, and barrier or other methods between the baseline survey (2017-2018) and 3 subsequent surveys (2019-2021). Results A total of 1344 female participants (mean [SD] age, 34 [7] years) completed the first survey (667 in Alabama and 677 in South Carolina). Use of LARC significantly increased in South Carolina (119 [17.6%] to 138 [21.1%]) compared with Alabama (120 [18.0%] to 116 [18.1%]; P = .004). Use of IUDs increased in South Carolina (95 [14.0%] to 114 [17.4%]) compared with Alabama (92 [13.8%] to 102 [15.9%]; P = .003). These associations persisted in the adjusted analysis, with a significant increase in the odds of LARC (adjusted odds ratio, 1.24; 95% CI, 1.06-1.44) and IUD (adjusted odds ratio, 1.19; 95% CI, 1.06-1.32) use at follow-up in South Carolina compared with Alabama. Conclusions and Relevance In this cohort study of 1344 participants, increases in the use of IUDs in South Carolina were noted after the implementation of the South Carolina Choose Well initiative that were not observed in a peer state with no intervention. Our findings may provide support in favor of statewide contraceptive access initiatives and their role in promoting access to reproductive health services.
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Affiliation(s)
- Nathan Hale
- Center for Applied Research and Evaluation in Women’s Health and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City
| | - Jusung Lee
- College for Health, Community and Policy, University of Texas at San Antonio, San Antonio
| | - Jordan de Jong
- Center for Applied Research and Evaluation in Women’s Health and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City
| | - Michael G. Smith
- Center for Applied Research and Evaluation in Women’s Health and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City
| | - Amal J. Khoury
- Center for Applied Research and Evaluation in Women’s Health and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City
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Hale N, Dehlendorf C, Smith MG, Stapleton J, McCartt P, Khoury AJ. Contraceptive counseling, method satisfaction, and planned method continuation among women in the U.S. southeast. Contraception 2024; 132:110365. [PMID: 38215919 DOI: 10.1016/j.contraception.2024.110365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVES We used the validated Person-Centered Contraceptive Counseling (PCCC) scale to examine experiences with counseling and associations between counseling quality, method satisfaction, and planned method continuation at the population level in two southeastern states. STUDY DESIGN We used data from the Statewide Survey of Women, a probability-based sample of reproductive-aged women in Alabama and South Carolina in 2017/18. We included women using a contraceptive method and reporting a contraceptive visit in the past year (n = 1265). Respondents rated their most recent provider experience across four PCCC items. Regression analyses examined relationships between counseling quality and outcomes of interest, and path analysis examined the extent to which method satisfaction mediated the effects of counseling quality on planned continuation. RESULTS Over half of participants (54%) reported optimal contraceptive counseling. Optimal counseling was associated with method satisfaction (aPR = 1.16; 95% confidence interval (CI) = 1.04-1.29) in adjusted models. Optimal counseling was marginally associated with planned discontinuation in the bivariate analysis but was attenuated in the adjusted model (aPR = 1.07; 95% CI = 0.98-1.18). In the path analysis, counseling quality influenced method satisfaction (0.143 (0.045), p = 0.001) which influenced planned continuation, controlling for PCCC (0.74 (0.07), p < 0.001). The total indirect effect of counseling quality on planned continuation was significant (0.106 (0.03), p = 0.001), and a residual direct effect from counseling quality to planned continuation was noted (0.106 (0.03), p = 0.001). CONCLUSIONS Counseling quality is independently associated with method satisfaction at the population level. The effect of counseling on planned continuation is partially mediated by method satisfaction. IMPLICATIONS Interventions to support person-centered contraceptive counseling promise to improve quality of care, patient experience with care, and reproductive outcomes.
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Affiliation(s)
- Nathan Hale
- Center for Applied Research and Evaluation in Women's Health and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, United States.
| | - Christine Dehlendorf
- Person-Centered Reproductive Health Program, Department of Family and Community Medicine, University of California, San Francisco, CA, United States
| | - Michael G Smith
- Center for Applied Research and Evaluation in Women's Health and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, United States
| | - Jerod Stapleton
- Department of Health, Behavior and Society, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Paezha McCartt
- Ballad Health, Office of Population Health, Johnson City, TN, United States
| | - Amal J Khoury
- Center for Applied Research and Evaluation in Women's Health and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, United States
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Hale N, Manalew WS, Leinaar E, Smith M, Sen B, Khoury A. Impact of the Choose Well Contraceptive Access Initiative on Method Use Among Women Enrolled in South Carolina's Medicaid Program: A Mid-line Assessment. Womens Health Issues 2023; 33:626-635. [PMID: 37580186 DOI: 10.1016/j.whi.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION A six-year statewide contraceptive access initiative focused on equitable access to contraception, removing cost barriers, capacity building and training, raising consumer awareness, and expanding contraceptive care at safety net clinics was implemented in South Carolina beginning in 2017. This study assessed changes in contraceptive method use among women enrolled in the South Carolina Medicaid program during the first three years of Choose Well. METHODS Contraception use among a retrospective cohort of women aged 15 to 45 enrolled in South Carolina Medicaid from 2012 to 2020 was examined. Interrupted time series regression analysis was used to assess changes in the use of intrauterine devices (IUDs) and contraceptive implants between 2012 and 2016 and 2017 and 2020. Analyses were conducted for all women and stratified by age groups. RESULTS Long-acting reversible contraception use increased from 8.5% during the pre-Choose Well period to 10.9% during the Choose Well period (p < .001), with IUD use increasing from 4.3% to 5.2% (p < .001) and implant use increasing from 4.6% to 6.0% (p < .001). The interrupted time series analysis found a significant positive change in the average level of monthly IUD use after Choose Well began (0.493 percentage points; 95% confidence interval, 0.311-0.675). The effect was stronger among women 20 to 25 years of age. Choose Well significantly increased the trend in IUD use among all women by a positive 0.013 percentage points (95% confidence interval, 0.006-0.020) per month beyond expected values. CONCLUSIONS At the mid-point of the Choose Well Evaluation, the use of IUD methods increased significantly beyond what would be expected had pre-Choose Well trends continued. This was particularly evident among women 20 to 25 years of age. These findings suggest that Choose Well succeeded in reducing barriers to the use of IUDs.
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Affiliation(s)
- Nathan Hale
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee.
| | - Wondimu S Manalew
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Edward Leinaar
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Michael Smith
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Bisakha Sen
- Department of Health Care Organization & Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Amal Khoury
- Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee; Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
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Beatty K, Smith MG, de Jong J, Weber A, Adelli R, Khoury A. Impact of the Choose Well Initiative on Contraceptive Access at Federally Qualified Health Centers in South Carolina: A Midline Evaluation. Am J Public Health 2023; 113:1167-1172. [PMID: 37651659 PMCID: PMC10568501 DOI: 10.2105/ajph.2023.307384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Choose Well (CW) is a statewide contraceptive access initiative to reduce unintended pregnancy among patients utilizing federally funded family planning services. We examined CW's impact on contraceptive access at South Carolina federally qualified health centers from 2016 to 2019, which reported significantly higher increases in providing the full range of contraceptive methods and training onsite. CW prioritized ensuring change sustainability through obtaining funding and institutionalizing changes. (Am J Public Health. 2023;113(11):1167-1172. https://doi.org/10.2105/AJPH.2023.307384).
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Affiliation(s)
- Kate Beatty
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Michael G Smith
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Jordan de Jong
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Amy Weber
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Rakesh Adelli
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
| | - Amal Khoury
- All authors are with the College of Public Health, East Tennessee State University, Johnson City
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Fuentes L, Douglas-Hall A, Geddes CE, Kavanaugh ML. Primary and reproductive healthcare access and use among reproductive aged women and female family planning patients in 3 states. PLoS One 2023; 18:e0285825. [PMID: 37224157 DOI: 10.1371/journal.pone.0285825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/02/2023] [Indexed: 05/26/2023] Open
Abstract
Public funding plays a key role in reducing cost barriers to sexual and reproductive health (SRH) care in the United States. In this analysis, we examine sociodemographic and healthcare seeking profiles of individuals in three states where public funding for health services has recently changed: Arizona, Iowa, and Wisconsin. In addition, we examine associations between individuals' health insurance status and whether they experienced delays or had trouble in obtaining their preferred contraception. This descriptive study draws on data collected between 2018 to 2021 in two distinct cross-sectional surveys in each state, one among a representative sample of female residents aged 18-44 and the other among a representative sample of female patients ages eighteen and older seeking family planning services at healthcare sites that receive public funding to deliver this care. The majority of reproductive-aged women and female family planning patients across states reported having a personal healthcare provider, had received at least one SRH service in the preceding 12 months, and were using a method of birth control. Between 49-81% across groups reported receiving recent person-centered contraceptive care. At least one-fifth of each group reported wanting healthcare in the past year but not getting it, and between 10-19% reported a delay or trouble getting birth control in the past 12 months. Common reasons for these outcomes involved cost and insurance-related issues, as well as logistical ones. Among all populations except Wisconsin family planning clinic patients, those with no health insurance had greater odds of being delayed or having trouble getting desired birth control in the past 12 months than those with health insurance. These data serve as a baseline to monitor access and use of SRH services in Arizona, Wisconsin, Iowa in the wake of drastic family planning funding shifts that changed the availability and capacity of the family planning service infrastructure across the country. Continuing to monitor these SRH metrics is critical to understand the potential effect of current political shifts.
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Affiliation(s)
- Liza Fuentes
- Formerly of the Research Division, Guttmacher Institute, New York, New York, United States of America
| | - Ayana Douglas-Hall
- Research Division, Guttmacher Institute, New York, New York, United States of America
| | - Christina E Geddes
- Research Division, Guttmacher Institute, New York, New York, United States of America
| | - Megan L Kavanaugh
- Research Division, Guttmacher Institute, New York, New York, United States of America
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Kavanaugh ML, Zolna MR. Where Do Reproductive-Aged Women Want to Get Contraception? J Womens Health (Larchmt) 2023. [PMID: 37099807 DOI: 10.1089/jwh.2022.0406] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Background: People's preferences regarding how they want to obtain contraception should be considered when building and refining high-quality contraceptive care programs, especially in light of recent shifts to incorporate more telehealth options into contraceptive care due to the coronavirus disease 2019 (COVID-19) pandemic. Methods: Our study is a cross-sectional analysis of population-representative surveys conducted between November 2019 and August 2020 among women aged 18-44 years in Arizona (N = 885), New Jersey (N = 952), and Wisconsin (N = 967). We use multivariable logistic regression to identify characteristics associated with each of five contraception source preference groups (in-person via health care provider, offsite with a provider via telemedicine, offsite without a provider via telehealth, at a pharmacy, or via innovative strategies), and we examine associations between contraceptive care experiences and perceptions and each preference group. Results: Across states, most respondents (73%) expressed preferences for obtaining contraception via more than one source. One quarter indicated a narrow preference for obtaining contraception in-person from a provider, 19% expressed interest in doing so offsite with a provider via telemedicine, 64% for doing so offsite without a provider via telehealth, 71% reported interest in pharmacy-based contraception, and 25% indicated interest in getting contraception through innovative strategies. Those who had experienced nonperson-centered contraceptive counseling reported higher levels of interest in telehealth and innovative sources, and those who expressed mistrust in the contraceptive care system had higher levels of preferring to obtain contraception offsite, via telemedicine, telehealth, and other innovative avenues. Conclusions: Policies that ensure access to a diversity of contraceptive sources, which acknowledge and address people's past experiences of contraceptive care, have the greatest likelihood of closing the gap between people's contraceptive access preferences and realities.
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Affiliation(s)
| | - Mia R Zolna
- Research Division, Guttmacher Institute, New York, New York, USA
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9
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Congy J, Bouyer J, de La Rochebrochard E. Low-income women and use of prescribed contraceptives in the context of full health insurance coverage in France, 2019. Contraception 2023; 121:109976. [PMID: 36758736 DOI: 10.1016/j.contraception.2023.109976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Major socioeconomic differences in contraceptive use are observed in high-income countries. Cost is often cited as a main factor to explain these differences but other barriers may also exist. Our aim was to compare prescribed contraceptive use among low-income and non-low-income women in a national context of full health insurance coverage. STUDY DESIGN In the French national health insurance database, we selected all women (14.8 million) aged 15-49 years living in France in 2019. We compared the prevalence of use of each prescribed contraceptive between low-income and non-low-income women: oral contraceptives, copper intrauterine devices (IUDs), the levonorgestrel intrauterine system (LNG-IUS), and implants. RESULTS In the study population, 11% had a low income. Fewer low-income women used prescribed contraceptives than non-low-income women (36% vs. 46%, p < 0.001). When using a contraceptive, low-income women used a different method: at 20-24 years old, they used less oral contraceptives (60% vs. 77%, p < 0.001) and more implants (22% vs. 9%, p < 0.001), while at 40-44 years, they used less levonorgestrel intrauterine systems (18% vs. 30%, p < 0.001). CONCLUSIONS Even in a national context of free access to medical care for low-income women, they use less and different prescribed contraceptives than non-low-income women. These results could reflect barriers other than financial cost to the use of prescribed contraceptives by low-income women. IMPLICATIONS Financial barriers need to be removed in order to increase contraceptive use. However, this may not be sufficient and further research should explore barriers that low-income women may encounter in accessing and choosing their contraception.
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Affiliation(s)
- Juliette Congy
- Institut National d'Etudes Démographiques, Ined, Sexual and Reproductive Health and Rights Unit - UR14, 9 cours des Humanités, Aubervilliers, France.
| | - Jean Bouyer
- Institut National d'Etudes Démographiques, Ined, Sexual and Reproductive Health and Rights Unit - UR14, 9 cours des Humanités, Aubervilliers, France; Université Paris-Saclay, UVSQ, Inserm, CESP, 16 avenue Paul Vaillant Couturier, Villejuif, France
| | - Elise de La Rochebrochard
- Institut National d'Etudes Démographiques, Ined, Sexual and Reproductive Health and Rights Unit - UR14, 9 cours des Humanités, Aubervilliers, France; Université Paris-Saclay, UVSQ, Inserm, CESP, 16 avenue Paul Vaillant Couturier, Villejuif, France
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Rocca CH, Smith MG, Hale NL, Khoury AJ. Ranges of pregnancy preferences and contraceptive use: Results from a population-based survey in the southeast United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:90-98. [PMID: 36071572 DOI: 10.1363/psrh.12205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CONTEXT Understanding how pregnancy preferences shape contraceptive use is essential for guiding contraceptive interventions and policies that center individuals' preferences and desires. Lack of rigorous measurement of pregnancy preferences, particularly on the population level, has been a methodologic challenge. METHODS We investigated associations between prospective pregnancy preferences, measured with a valid instrument, the Desire to Avoid Pregnancy (DAP) scale, and contraceptive use in a representative sample of 2601 pregnancy-capable self-identified women, aged 18-44 years, in Alabama and South Carolina (2017-2018). We used multivariable regression with weighting to investigate how probability of modern contraceptive use, and use of different contraceptive method types, changed with increasing preference to avoid pregnancy. RESULTS Desire to Avoid Pregnancy scale scores (range:0-4, 4 = greater preference to avoid pregnancy, median = 2.29, IQR: 1.57-3.14; α:0.95) were strongly associated with contraceptive use among sexually active respondents (aPR = 1.15 [1.10, 1.20]; predicted 45% using contraception among DAP = 0, 62% among DAP = 2, 86% among DAP = 4). Method types used did not differ by DAP score. The most common reasons for nonuse were concern over side effects and not wanting to use a method (32% each) among respondents with mid-range and high DAP scores. Among those with mid-range DAP scores, 20% reported nonuse due to not minding if pregnancy were to occur (vs. 0% among those with high DAP scores). CONCLUSIONS Pregnancy preferences strongly influence likelihood of contraceptive use. Providion of appropriate contraceptive care to those not explicitly desiring pregnancy must differentiate between ranges of feelings about pregnancy, perceived drawbacks to contraceptive use, and legitimate psychological and interpersonal benefits of nonuse to promote autonomy in contraceptive decision-making.
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Affiliation(s)
- Corinne H Rocca
- Department of Obstetrics, Gynecology and Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, School of Medicine, Oakland, California, USA
| | - Michael G Smith
- College of Public Health, Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee, USA
| | - Nathan L Hale
- College of Public Health, Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amal J Khoury
- College of Public Health, Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee, USA
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11
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Smith MG, Hale N, Kelley S, Satterfield K, Beatty KE, Khoury AJ. South Carolina's Choose Well Initiative to Reduce Unintended Pregnancy: Rationale, Implementation Design, and Evaluation Methodology. Am J Public Health 2022; 112:S484-S489. [PMID: 35767793 PMCID: PMC10490316 DOI: 10.2105/ajph.2022.306889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Michael G Smith
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
| | - Nathan Hale
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
| | - Sarah Kelley
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
| | - Katherine Satterfield
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
| | - Kate E Beatty
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
| | - Amal J Khoury
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
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Manalew W, Hale N, Leinaar E, Sen B, Smith M, Khoury A. Medicaid Cost Savings from Provision of Contraception to Beneficiaries in South Carolina, 2012–2018. Popul Health Manag 2022; 25:542-550. [DOI: 10.1089/pop.2021.0392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- W.Samuel Manalew
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Nathan Hale
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Edward Leinaar
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Bisakha Sen
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Michael Smith
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amal Khoury
- Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
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Mann AK, Khoury A, McCartt P, Smith MG, Hale N, Beatty K, Johnson L. Multilevel Influences on Providers' Delivery of Contraceptive Services: A Qualitative Thematic Analysis. WOMEN'S HEALTH REPORTS 2022; 3:491-499. [PMID: 35651999 PMCID: PMC9148650 DOI: 10.1089/whr.2021.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/12/2022]
Abstract
Introduction: Access to a full range of contraceptive services is essential for quality health care. Contraceptive provision practices of primary care providers play an important role in patients' decision-making about their reproductive health care. Understanding the multilevel factors influencing contraceptive care delivery in primary care settings is critical for advancing quality care. This study offers an in-depth examination of influences on providers' delivery of contraceptive services across multiple primary care specialties and practice settings to identify issues and strategies to improve care. Materials and Methods: Twenty-four in-depth face-to-face interviews were conducted in 2017 with primary care providers, including family physicians, gynecologists, pediatricians, and nurse practitioners from academic settings, private practices, and health centers. Interviews were transcribed and analyzed thematically. Results: Providers described a complex set of influences on their provision of contraception across multiple ecological contexts. Seven major themes emerged from the qualitative analysis, including six types of influence on provision of contraception: organizational, individual provider-related, structural and policy, individual patient-related, community, and the lack of influences or barriers. Providers also discussed the sources they access for information about evidence-based contraception counseling. Conclusions: A diverse set of providers described a complex system in which multiple concentric ecological contexts both positively and negatively influence the ways in which they provide contraceptive services to their patients. To close the gaps in contraceptive service delivery, it is important to recognize that both barriers and facilitators to patient-centered contraceptive counseling exist simultaneously across multiple ecological contexts.
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Affiliation(s)
- Abbey K. Mann
- Department of Family Medicine, Quillen College of Medicine, and College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amal Khoury
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Paezha McCartt
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Michael G. Smith
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Nathan Hale
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Kate Beatty
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Leigh Johnson
- Department of Family Medicine, Quillen College of Medicine, and College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
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Swan LE, Hales T, Ely GE, Auerbach SL, Agbemenu K. Validation of the short-form reproductive coercion scale with Appalachian women. Contraception 2021; 104:265-270. [DOI: https:/doi.org/10.1016/j.contraception.2021.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
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Beatty KE, Smith MG, Khoury AJ, Zheng S, Ventura LM, Okwori G. Accessibility of federally funded family planning services in South Carolina and Alabama. Prev Med Rep 2021; 22:101343. [PMID: 33767947 PMCID: PMC7980054 DOI: 10.1016/j.pmedr.2021.101343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/12/2021] [Accepted: 02/20/2021] [Indexed: 11/23/2022] Open
Abstract
This study operationalized the five dimensions of health care access in the context of contraceptive service provision and used this framework to examine access to contraceptive care at health department (HD) (Title X funded) and federally qualified health center (FQHC) (primarily non-Title X funded) clinics in South Carolina and Alabama. A cross-sectional survey was conducted in 2017/18 that assessed clinic-level characteristics, policies, and practices related to contraceptive provision. Provision of different contraceptive methods was examined between clinic types. Survey items were mapped to the dimensions of access and internal consistency for each scale was tested with Cronbach's alpha. Scores of access were developed and differences by clinic type were evaluated with an independent t-test. The overall response rate was 68.3% and the sample included 235 clinics. HDs (96.9%) were significantly more likely to provide IUDs and/or Impants on-site than FQHCs (37.4%) (P < 0.0001). Scales with the highest consistency were Availability: Clinical Policy (24 items) (alpha = 0.892) and Acceptability (43 items) (alpha = 0.834). HDs had higher access scores than FQHCs for the Availability: Clinical Policy scale (0.58, 95% CL 0.55, 0.61) vs (0.29, 95% CL 0.25, 0.33) and Affordability: Administrative Policy scale (0.86, 95% CL 0.83, 0.90) vs (0.47, 95% CL 0.41, 0.53). FQHCs had higher access scores than HDs for Affordability: Insurance Policy (0.78, 95% CL 0.72, 0.84) vs (0.56, 95% CL 0.53, 0.59). These findings highlight strengths and gaps in contraceptive care access. Future studies must examine the impact of each dimension of access on clinic-level contraceptive utilization.
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Affiliation(s)
- Kate E Beatty
- Center for Applied Research and Evaluation in Women's Health, Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, P.O. Box 70264, Johnson City, TN 37614, United States
| | - Michael G Smith
- Center for Applied Research and Evaluation in Women's Health, Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, P.O. Box 70264, Johnson City, TN 37614, United States
| | - Amal J Khoury
- Center for Applied Research and Evaluation in Women's Health, Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, P.O. Box 70264, Johnson City, TN 37614, United States
| | - Shimin Zheng
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, 149 Lamb Hall, P.O. Box 70259, Johnson City, TN 37614, United States
| | - Liane M Ventura
- Center for Applied Research and Evaluation in Women's Health, Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, P.O. Box 70264, Johnson City, TN 37614, United States
| | - Glory Okwori
- Center for Applied Research and Evaluation in Women's Health, Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, P.O. Box 70264, Johnson City, TN 37614, United States
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Validation of the short-form reproductive coercion scale with Appalachian women. Contraception 2021; 104:265-270. [PMID: 33930381 DOI: 10.1016/j.contraception.2021.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the psychometric properties of the short-form Reproductive Coercion Scale among a sample of Appalachian women. STUDY DESIGN We recruited a purposive sample of Appalachian women, using targeted Facebook ads to collect data via an online survey in fall 2019. We randomly split our sample into two independent samples and used exploratory factor analysis on sample 1 (N = 314) and confirmatory factor analysis on sample 2 (N = 314) in order to cross-validate our findings. RESULTS Findings indicated that the short-form Reproductive Coercion Scale is a valid and reliable instrument to assess reproductive coercion among this sample of Appalachian women. Our findings indicated that, in this Appalachian sample, the reduced, five-item Reproductive Coercion Scale measured a unidimensional construct and was not comprised of the multiple dimensions of pregnancy coercion and condom manipulation. As expected, intimate partner violence and pregnancy fatalism were significantly and positively associated with reproductive coercion while religious affiliation and insurance status were not significantly associated with reproductive coercion. These findings help build construct validity for the short-form Reproductive Coercion Scale with this sample. CONCLUSION While pregnancy coercion and condom manipulation are often considered independent reproductive coercion factors, the current study indicates that, in this Appalachian sample, the short-form Reproductive Coercion Scale measures a single latent reproductive coercion factor. IMPLICATIONS While pregnancy coercion and condom manipulation are often considered independent reproductive coercion factors, the current study indicates that, in this Appalachian sample, the short-form Reproductive Coercion Scale measures a single latent reproductive coercion factor. Additional research may be needed to confirm the factor structure of the short-form Reproductive Coercion Scale across populations and geographic conditions.
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