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Sudhinaraset M, Gipson JD, Nakphong MK, Soun B, Afulani PA, Upadhyay UD, Patil R. Person-centered abortion care scale: Validation for medication abortion in the United States. Contraception 2024:110485. [PMID: 38754758 DOI: 10.1016/j.contraception.2024.110485] [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: 10/04/2023] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE Medication abortions now make up the majority of abortions in the US, with new service delivery models such as telehealth; however, it is unclear how this may impact patient experiences. The objective of the study is to adapt and validate a person-centered abortion care (PCAC) scale for medication abortions that was developed in a global South context (Kenya) for use in the United States. STUDY DESIGN This study includes medication abortion patients from a hospital-based clinic who had one of two modes of service delivery: (1) telemedicine with no physical exam or ultrasound; or (2) in-person with clinic-based exams and ultrasounds. We conducted a sequential approach to scale development including: (1) defining constructs and item generation; (2) expert reviews; (3) cognitive interviews (n = 12); (4) survey development and online survey data collection (N = 182, including 45 telemedicine patients and 137 in-person patients); and (5) psychometric analyses. RESULTS Exploratory factor analyses identified 29-items for the US-PCAC scale with three subscales: (1) Respect and Dignity (10 items), (2) Responsive and Supportive Care (nine items for the full scale, one additional mode-specific item each for in-person and telemedicine), and (3) Communication and Autonomy (10 items for the full scale, one additional item for telemedicine). The US-PCAC had high content, construct, and criterion validity. It also had high reliability, with a standardized alpha for the full 29-item US-PCAC scale of 0.95. The US-PCAC score was associated with overall satisfaction. CONCLUSION This study found high validity and reliability of a newly-developed person-centered abortion care scale for use in the US. As medication abortion provision expands, this scale can be used in quality improvement efforts. IMPLICATIONS This study found high validity and reliability of a newly-developed person-centered care scale for use in the United States for in-person and telemedicine medication abortion.
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Affiliation(s)
- May Sudhinaraset
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, United States; UCLA Bixby Center to Advance Sexual and Reproductive Health Equity, University of California, Los Angeles, CA, United States.
| | - Jessica D Gipson
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, United States; UCLA Bixby Center to Advance Sexual and Reproductive Health Equity, University of California, Los Angeles, CA, United States
| | - Michelle K Nakphong
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, CA, United States
| | - Brenda Soun
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Patience A Afulani
- Epidemiology and Biostatistics Department, University of California, San Francisco, CA, United States; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Ushma D Upadhyay
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Rajita Patil
- UCLA Bixby Center to Advance Sexual and Reproductive Health Equity, University of California, Los Angeles, CA, United States; David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, United States
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Koenig LR, Ko J, Valladares ES, Coeytaux FM, Wells E, Lyles CR, Upadhyay UD. Patient Acceptability of Telehealth Medication Abortion Care in the United States, 2021‒2022: A Cohort Study. Am J Public Health 2024; 114:241-250. [PMID: 38237103 PMCID: PMC10862199 DOI: 10.2105/ajph.2023.307437] [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] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
Objectives. Despite the recent expansion of direct-to-patient telehealth abortion care in the United States, patient experiences with the service are not well understood. Methods. We described care experiences of 1600 telehealth abortion patients in 2021 to 2022 and used logistic regression to explore differences by race or ethnicity and between synchronous (phone or video) and asynchronous (secure messaging) telehealth abortion care. Results. Most patients trusted the provider (98%), felt telehealth was the right decision (96%), felt cared for (92%), and were very satisfied (89%). Patients most commonly cited privacy (76%), timeliness (74%), and staying at home (71%) as benefits. The most commonly reported drawback was initial uncertainty about whether the service was legitimate (38%). Asian patients were less likely to be very satisfied than White patients (79% vs 90%; P = .008). Acceptability was high for both synchronous and asynchronous care. Conclusions. Telehealth abortion care is highly acceptable, and benefits include privacy and expediency. Public Health Implications. Telehealth abortion can expand abortion access in an increasingly restricted landscape while maintaining patient-centered care. (Am J Public Health. 2024;114(2):241-250. https://doi.org/10.2105/AJPH.2023.307437).
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Affiliation(s)
- Leah R Koenig
- Leah R. Koenig, Jennifer Ko, and Ushma D. Upadhyay are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland. Ena Suseth Valladares is with California Latinas for Reproductive Justice, Los Angeles. Francine M. Coeytaux and Elisa Wells are with Plan C. Courtney R. Lyles is with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Jennifer Ko
- Leah R. Koenig, Jennifer Ko, and Ushma D. Upadhyay are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland. Ena Suseth Valladares is with California Latinas for Reproductive Justice, Los Angeles. Francine M. Coeytaux and Elisa Wells are with Plan C. Courtney R. Lyles is with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Ena Suseth Valladares
- Leah R. Koenig, Jennifer Ko, and Ushma D. Upadhyay are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland. Ena Suseth Valladares is with California Latinas for Reproductive Justice, Los Angeles. Francine M. Coeytaux and Elisa Wells are with Plan C. Courtney R. Lyles is with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Francine M Coeytaux
- Leah R. Koenig, Jennifer Ko, and Ushma D. Upadhyay are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland. Ena Suseth Valladares is with California Latinas for Reproductive Justice, Los Angeles. Francine M. Coeytaux and Elisa Wells are with Plan C. Courtney R. Lyles is with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Elisa Wells
- Leah R. Koenig, Jennifer Ko, and Ushma D. Upadhyay are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland. Ena Suseth Valladares is with California Latinas for Reproductive Justice, Los Angeles. Francine M. Coeytaux and Elisa Wells are with Plan C. Courtney R. Lyles is with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Courtney R Lyles
- Leah R. Koenig, Jennifer Ko, and Ushma D. Upadhyay are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland. Ena Suseth Valladares is with California Latinas for Reproductive Justice, Los Angeles. Francine M. Coeytaux and Elisa Wells are with Plan C. Courtney R. Lyles is with the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Ushma D Upadhyay
- Leah R. Koenig, Jennifer Ko, and Ushma D. Upadhyay are with Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland. Ena Suseth Valladares is with California Latinas for Reproductive Justice, Los Angeles. Francine M. Coeytaux and Elisa Wells are with Plan C. Courtney R. Lyles is with the Department of Epidemiology and Biostatistics, University of California, San Francisco
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Dunlop H, Sinay AM, Kerestes C. Telemedicine Abortion. Clin Obstet Gynecol 2023; 66:725-738. [PMID: 37910115 DOI: 10.1097/grf.0000000000000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Telemedicine has become a substantial part of abortion care in recent years. In this review, we discuss the history and regulatory landscape of telemedicine for medication abortion in the United States, different models of care for telemedicine, and the safety and effectiveness of medication abortion via telemedicine, including using history-based screening protocols for medication abortion without ultrasound. We also explore the acceptability of telemedicine for patients and their perspectives on its benefits, as well as the use of telemedicine for other parts of abortion care. Telemedicine has expanded access to abortion for many, although there remain limitations to its implementation.
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Affiliation(s)
| | - Anne-Marie Sinay
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Courtney Kerestes
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
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