Information Poverty and Reproductive Healthcare: Assessing the Reasons for Inequity between Income Groups

Reproductive justice for unhoused women: An integrative review of the literature

This review examines the reproductive health experiences of unhoused women and youth. Guided by the reproductive justice framework, this review examines barriers to accessing contraception, medical abortion, and prenatal care while homeless. Twenty-one articles were identified through keyword searches in Google Scholar, Ebscohost Academic Search Premier, and PsycINFO. In included articles, barriers were identified at the individual, relational, and contextual levels. Findings from this scoping review illustrate the need to examine multiple levels of analysis when seeking to improve access to family planning services for individuals experiencing homelessness. Included literature suggests an overabundance of research documenting barriers to contraceptive care relative to the literature examining abortion and prenatal care experiences and a scarcity of research examining barriers to reproductive justice among unhoused individuals who do not identify as women.

Policy impacts on contraceptive access in the United States: a scoping review

Contraceptive access is influenced by policy decisions, which can expand and constrict the contraceptive options available. This study explored the impact of recent US federal policies on contraceptive access by identifying and reviewing empirical literature, which is then presented and discussed using Levesque et al.’s (2013) healthcare access framework. A scoping review was conducted to identify empirical studies (N = 96) examining the impact of recent federal policy (passed from 2009 to 2019) on contraceptive access. Most identified studies examined the role of the Affordable Care Act (n = 53) and Title X of the Public Health Service Act (n = 25), showing many benefits of both policies for contraceptive access, particularly through improved affordability, availability, and appropriateness of contraceptive care. Other identified studies examined the impact of policies funding abstinence-only sex education (n = 2) and the Teen Pregnancy Prevention Program (n = 3), military policies related to the availability of contraception (n = 1), guidelines for quality contraceptive care (n = 3), Title IX of the Education Amendments (n = 4), the Violence Against Women Act (n = 1), and the Veterans Access, Choice, and Accountability Act (n = 4). Through increased outreach efforts, normalising of care, availability of services, cost subsidies, and provider competencies, recent federal policy has, overall, enhanced contraceptive access across the dimensions of healthcare access. Numerous policy and practice gaps and needs are identified, and future directions for research, policy, and practice are suggested.

Policy impacts on contraceptive access in the United States: a scoping review

Contraceptive access is influenced by policy decisions, which can expand and constrict the contraceptive options available. This study explored the impact of recent US federal policies on contraceptive access by identifying and reviewing empirical literature, which is then presented and discussed using Levesque et al.’s (2013) healthcare access framework. A scoping review was conducted to identify empirical studies (N = 96) examining the impact of recent federal policy (passed from 2009 to 2019) on contraceptive access. Most identified studies examined the role of the Affordable Care Act (n = 53) and Title X of the Public Health Service Act (n = 25), showing many benefits of both policies for contraceptive access, particularly through improved affordability, availability, and appropriateness of contraceptive care. Other identified studies examined the impact of policies funding abstinence-only sex education (n = 2) and the Teen Pregnancy Prevention Program (n = 3), military policies related to the availability of contraception (n = 1), guidelines for quality contraceptive care (n = 3), Title IX of the Education Amendments (n = 4), the Violence Against Women Act (n = 1), and the Veterans Access, Choice, and Accountability Act (n = 4). Through increased outreach efforts, normalising of care, availability of services, cost subsidies, and provider competencies, recent federal policy has, overall, enhanced contraceptive access across the dimensions of healthcare access. Numerous policy and practice gaps and needs are identified, and future directions for research, policy, and practice are suggested.

Pathways to reproductive autonomy: Using path analysis to predict family planning outcomes in the United States

In the United States, about half of pregnancies are unintended, and most women of reproductive age are at risk of unintended pregnancy. Research has explored predictors of contraceptive use and unintended pregnancy, but there is a lack of research regarding access to preferred contraceptive method(s) and the complex pathways from sociodemographic factors to these family planning outcomes. This study applied Levesque et al.'s (2013) healthcare access framework to investigate pathways from sociodemographic factors and indicators of access to family planning outcomes using secondary data. Data were collected at four time points via an online survey between November 2012 and June 2014. Participants were US women of reproductive age who were seeking to avoid pregnancy (N = 1036; M_age  = 27.91, SD = 5.39; 6.9% Black, 13.6% Hispanic, 70.2% white, 9.4% other race/ethnicity). We conducted mediational path analysis, and results indicated that contraceptive knowledge (β = 0.116, p = 0.004), insurance coverage (β = 0.423, p < 0.001), and relational provider engagement (β = 0.265, p = 0.011) were significant predictors of access to preferred contraceptive method. Access to preferred contraceptive method directly predicted use of more effective contraception (β = 0.260, p < 0.001) and indirectly predicted decreased likelihood of experiencing unintended pregnancy via contraceptive method(s) effectiveness (β = -0.014, 95% confidence interval: -0.041, -0.005). This study identifies pathways to and through access to preferred contraceptive methods that may be important in determining family planning outcomes such as contraceptive use and unintended pregnancy. This information can be used to improve access to contraception, ultimately increasing reproductive autonomy by helping family planning outcomes align with patients' needs and priorities.

Internet-Based Information Behavior After Pregnancy Loss: Interview Study

BACKGROUND

Information behavior describes all human behaviors in relation to information. Individuals experiencing disruption or stigma often use internet-based tools and spaces to meet their associated information needs. One such context is pregnancy loss, which, although impactful and common, has been absent from much of feminist and reproductive health and information behavior scholarship. By understanding information behavior after pregnancy loss and accounting for it in designing internet-based information spaces, we can take a meaningful step toward countering the stigma and silence that many who experience such loss endure, facilitate coping, and make space for diverse pregnancy narratives in our society.

OBJECTIVE

This study's objective is to provide a characterization of internet-based information behavior after pregnancy loss.

METHODS

We examined internet-based information behavior after pregnancy loss through 9 in-depth interviews with individuals residing in the United States. We analyzed the data by using open and axial coding.

RESULTS

We identified the following three themes in relation to participants' information behavior in internet-based spaces: needed information types, information-related concerns, and information outcomes. We drew from information behavior frameworks to interpret the processes and concerns described by participants as they moved from recognizing information needs to searching for information and to using information and experiencing outcomes. Specifically, we aligned these themes with information use concepts from the information behavior literature-information search, knowledge construction, information production, information application, and information effects. Participants' main concerns centered on being able to easily find information (ie, searchability), particularly on topics that had already been covered (ie, persistence), and, once found, being able to assess the information for its relevance, helpfulness, and credibility (ie, assessability). We suggest the following design implications that support health information behavior: assessability, persistence, and searchability.

CONCLUSIONS

We examined internet-based information behavior in the context of pregnancy loss, an important yet silenced reproductive health experience. Owing to the prevalence of information seeking during pregnancy, we advocate that generic pregnancy-related information spaces should address the needs related to pregnancy loss that we identified in addition to spaces dedicated to pregnancy loss. Such a shift could not only support those who use these spaces to manage pregnancies and then experience a loss but also help combat the silence and stigma associated with loss and the linear and normative narrative by which pregnancies are often represented.

Protocol versus practice: Deviations from guidelines in low-risk twin deliveries in the United States

BACKGROUND

Medical guidelines recommend vaginal delivery for low-risk twin pregnancies because cesareans increase the probability of maternal morbidity and mortality. Yet, vaginal delivery rates for twins are considerably lower than for comparable singletons. One explanation for this disparity argues that greater risk associated with twins warrants increased surgical intervention. An alternative explanation is that twin deliveries are more likely to deviate from protocols that advise vaginal birth.

METHODS

Using the 2017 Natality Detail File (N = 3,197,401), we measured alignment of vaginal birth and trial of labor (TOL) with the American College of Obstetricians and Gynecologists' guidelines for twin and singleton no-indicated-risk births. We calculated predicted probabilities for the population and by maternal race/ethnicity to assess whether low rates of vaginal births among twins are explained by associated risk factors, or by deviations from recommended delivery methods.

RESULTS

Overall, 31.2% of twins were born vaginally compared with 79.4% of singletons. Controlling for indicated risks, the predicted probability of vaginal birth for twins was 0.49 and 0.85 for singletons. The predicted probability of TOL for twins was 0.18 and 0.47 for singletons. Maternal race/ethnicity was only weakly associated with mode of delivery. These findings indicate that no-indicated-risk twin pregnancies, across maternal racial/ethnic categories, have lower probabilities of vaginal birth and TOL than would be expected with widespread adherence to current guidelines.

CONCLUSIONS

Given the life-threatening consequences that may result from unnecessary surgical procedures, our findings highlight the need for further research to illuminate medical and nonmedical mechanisms driving nonadherence to clinical guidelines for twin births.

The impact of US policy on contraceptive access: a policy analysis

Background

Contraceptive access is influenced by policy decisions, which can expand and constrict the contraceptive options available. This study explored the impact of recent US federal policy on contraceptive access.

Methods

Federal policy changes impacting contraceptive access over the past decade were identified in grey literature. These policy changes were organized into a timeline and analyzed according to Levesque et al.'s (2013) five dimensions of healthcare access (approachability, acceptability, availability/accommodation, affordability, and appropriateness), noting the most salient healthcare dimension impacted by the policy change and analyzing whether, according to this framework, the policy created a theoretical increase or decrease in contraceptive access.

Results

Of those policy changes coded as increasing (n = 42) and decreasing (n = 28) contraceptive access, most were related to the affordability (increasing n = 13; decreasing n = 12), physical availability (increasing n = 10; decreasing n = 7), and appropriateness (increasing n = 12; decreasing n = 4) of contraceptive care. Policy changes largely followed partisan divides, with contraceptive access increasing in years with a Democratic president and decreasing when a Republican president was in office. Many policy changes were related to the Affordable Care Act (ACA) and Title X of the Public Health Services Act. The implementation of the ACA and subsequent updates to it have increased the affordability of contraception, whereas changes to Title X have decreased the availability and appropriateness of contraceptive care.

Conclusions

This study highlights recent policy changes impacting contraceptive access, organizing them according to the five dimensions of healthcare access. It outlines specific policy barriers to contraceptive access and provides suggestions for policy and practice action that will improve contraceptive access and reproductive autonomy. Opportunities to ensure contraceptive access for all Americans include promoting comprehensive sex education, extending the Community Health Center Fund, increasing contraceptive care options for people with employers who are exempted from the ACA contraceptive mandate, addressing discrimination and building trust in contraceptive care, and amplifying outreach efforts to combat misinformation and confusion created by continuous changes to key family planning policies. Continued research on the role of policy in determining reproductive autonomy is warranted, and practice and policy action is needed to improve contraceptive access.

The impact of US policy on contraceptive access: a policy analysis

BACKGROUND

Contraceptive access is influenced by policy decisions, which can expand and constrict the contraceptive options available. This study explored the impact of recent US federal policy on contraceptive access.

METHODS

Federal policy changes impacting contraceptive access over the past decade were identified in grey literature. These policy changes were organized into a timeline and analyzed according to Levesque et al.'s (2013) five dimensions of healthcare access (approachability, acceptability, availability/accommodation, affordability, and appropriateness), noting the most salient healthcare dimension impacted by the policy change and analyzing whether, according to this framework, the policy created a theoretical increase or decrease in contraceptive access.

RESULTS

Of those policy changes coded as increasing (n = 42) and decreasing (n = 28) contraceptive access, most were related to the affordability (increasing n = 13; decreasing n = 12), physical availability (increasing n = 10; decreasing n = 7), and appropriateness (increasing n = 12; decreasing n = 4) of contraceptive care. Policy changes largely followed partisan divides, with contraceptive access increasing in years with a Democratic president and decreasing when a Republican president was in office. Many policy changes were related to the Affordable Care Act (ACA) and Title X of the Public Health Services Act. The implementation of the ACA and subsequent updates to it have increased the affordability of contraception, whereas changes to Title X have decreased the availability and appropriateness of contraceptive care.

CONCLUSIONS

This study highlights recent policy changes impacting contraceptive access, organizing them according to the five dimensions of healthcare access. It outlines specific policy barriers to contraceptive access and provides suggestions for policy and practice action that will improve contraceptive access and reproductive autonomy. Opportunities to ensure contraceptive access for all Americans include promoting comprehensive sex education, extending the Community Health Center Fund, increasing contraceptive care options for people with employers who are exempted from the ACA contraceptive mandate, addressing discrimination and building trust in contraceptive care, and amplifying outreach efforts to combat misinformation and confusion created by continuous changes to key family planning policies. Continued research on the role of policy in determining reproductive autonomy is warranted, and practice and policy action is needed to improve contraceptive access.

The Policy Information Gap and Resettlers' Well-Being: Evidence from the Anti-Poverty Relocation and Resettlement Program in China

The widespread dissemination of policy information is necessary for the success of the public policy, but the distribution of information among vulnerable groups has received little attention. We examined a public policy that focuses on the poorest people in China, the anti-poverty relocation and settlement program (ARSP). The infrastructure in the region where the policy is implemented is weak, and the information literacy of resettlers is low. This study analyses the impact of the policy information gap on the subjective well-being of resettlers. We found that the distribution of policy information among the poor is uneven, and the resettlers compare the policy information they obtain with a reference group (working-age people and less-educated people in the same village/community) to generate a policy information gap. The policy information gap indirectly affects subjective well-being by affecting the probability that people will be exposed to risks due to policy. As the policy information gap increases, the subjective well-being of resettlers changes in an inverted U-shape. This impact varies significantly among different groups, policy implementation stages, and resettlement methods. Attention should be paid to the information acquisition ability of the vulnerable groups and the welfare effects of social comparison, and to improve the method of publicizing policy information, which helps to improve the well-being of resettlers.

Health information seeking behaviour: a concept analysis

BACKGROUND

In 2007, Lambert and Loiselle conducted an extensive concept analysis of the term health information seeking behaviour (HISB) to examine the concept's level of maturity and critically analyse its characteristics. Since their groundbreaking work, HISB has evolved with the proliferation of ICTs. The Internet is now a common and often preferred medium for the pursuit of health information.

OBJECTIVES

The previous analysis spanned 42 years of literature; this article describes an analysis of the last 10 years of literature on HISB and how online seeking has caused the concept to evolve in the literature.

METHODS

This study used the concept analysis methodology employed by Lambert and Loiselle in the original analysis. It also included a systematic search conducted in five databases to identify studies from 2007 to 2017, using similar inclusion criteria from the original study.

RESULTS

Of the more than 500 articles retrieved, 85 journal articles met the inclusion criteria. Consistent with the original work, articles that included outcomes were identified as either behavioural or cognitive.

CONCLUSION

Most of the attention of the works studied focused on individuals and their information source preferences. This HISB analysis can be incorporated with studies to understand how various communities seek information in online versus non-online contexts.

Socioeconomic differences in experiences with treatment of coronary heart disease: a qualitative study from the perspective of elderly patients

OBJECTIVES

This qualitative study aims to analyse socioeconomic differences in patients' experiences along the treatment pathway for coronary heart disease (CHD).

DESIGN

A longitudinal qualitative study using in-depth semistructured interviews to explore patients' experiences with treatment was conducted. We analysed the transcripts of the records according to qualitative content analysis and identified differences between patients with lower and higher socioeconomic status (SES) by comparing and contrasting the narratives.

SETTING

The University Hospital in Halle (Saale), Germany.

PARTICIPANTS

41 elderly patients (aged 59-80 years) who suffered from CHD.

RESULTS

From various patient's experiences along the pathway of care which were found to differ according to SES we derived three major themes: (1) information: patients with higher SES had greater knowledge about treatment and could use medical records as sources of information; (2) illness perception: patients with lower SES focused on improving symptoms and survival, while patients with higher SES focused on physical performance and disease management; and (3) perceived role in healthcare: patients with lower SES tended to delegate responsibility to healthcare professionals.

CONCLUSIONS

Differences in the patient's knowledge about treatment, their perceived role in healthcare and illness perception can be the factors and mechanisms that contribute to explain socioeconomic inequalities in the treatment of CHD. These factors should be considered in quantitative studies to better understand the disparities in treatment and mortality. We suggest that improving patient-physician communication and patient knowledge can change the patient's understanding of CHD and their perceived role in healthcare and reduce inequalities in CHD treatment.

TRIAL REGISTRATION NUMBER

DRKS00007839.