Exploring and Monitoring Privacy, Confidentiality, and Provider Bias in Sexual and Reproductive Health Service Provision to Young People: A Narrative Review

Post-Roe v Wade psychiatry: legal, clinical, and ethical challenges in psychiatry under abortion bans

In recent history, the world has witnessed a trend towards liberalization of abortion laws driven by an increasing understanding of the negative personal and public health consequences of criminalizing abortion. By contrast, several countries have recently implemented restrictive reproductive laws, joining the 112 countries where access to abortion care is banned completely or with narrow exceptions. On June 24, 2022, the US Supreme Court ruling in Dobbs v Jackson Women's Health Organization overturned its landmark decisions in Roe v Wade that established abortion until the point of viability of the fetus as a constitutional right. After Roe v Wade having been overturned, it is projected that many women in the USA will be prevented from accessing safe abortion care. Importantly, abortion bans not only impose constraints on patient autonomy, they also restrict physicians' ability to practice evidence-based medicine, which will negatively impact psychiatric care. It is therefore crucial for the practicing psychiatrist to be familiar with this new legal landscape. In this Personal View, we aim to provide a topical overview to help clinicians gain a clear understanding of legal, clinical, and ethical responsibilities, focusing on the USA. We also discuss the reality that psychiatrists might be called upon to determine medical necessity for an abortion on psychiatric grounds, which is new for most US psychiatrists. We predict that psychiatrists will be confronted with very difficult situations in which lawful and ethical conduct might be incongruent, and that abortion bans will result in greater numbers of patients needing psychiatric care from a system that is ill-prepared for additional demands.

Utilization of social franchising in family planning services: a Pakistan perspective

Introduction

Pakistan's private sector caters to around 65% of family planning users. Private sector family planning was promoted in the Delivering Accelerated Family Planning in Pakistan (DAFPAK) program by UK's Foreign, Commonwealth & Development Office (FCDO) in 2019. We use data from DAFPAK to analyze the clientele and products distributed by two major NGOs, Marie Stopes Society (MSS) and DKT Pakistan, that support private providers in Pakistan. We also examined the effect of COVID-19 on client visits and contraceptives uptake at private facilities in Pakistan.

Methods

DAFPAK used field validation surveys to analyze the volume of clients and products of 639 private facilities across three provinces (Punjab, KPK and Balochistan) of Pakistan. The data was collected in two phases (February 2020 and 2021) using multi-stage cluster sampling at 95% confidence level. Using a generalized negative binomial regression, facility-level characteristics and impact of COVID-19 was analyzed with the volume of clients and products given out at 95% confidence interval alongside descriptive analysis.

Results

DKT facilities covered 53% of the sample while MSS covered 47%, with 72% facilities in the rural areas. Average facility existence duration is 87 months (7.25 years). While the average experience of the facility staff is 52 months (4.33 years). MSS is serving more clients as compared to DKT during both phase 1 (IRR: 3.15; 95% CI: 2.74, 3.61) and phase 2 (IRR: 2.11; 95% CI: 1.79, 2.49). Similarly, MSS had a greater volume of products given out in both phases 1 (IRR: 1.89; 95% CI: 1.51, 2.38) and phase 2 (IRR: 2.57; 95% CI: 2.09, 3.14). In both phases, client visits and product distribution decreased when client privacy is invaded (IRR: 0.74; 95% CI: 0.67, 0.82 - phase 1) and (IRR: 0.83; 95% CI: 0.72, 0.97 - phase 2). Lastly, during COVID-19, products distribution decreased by a factor of 0.84 (IRR: 0.84; 95% CI: 0.72, 0.97) but client visits remain unaffected.

Conclusion

Overall, clientele is low for all facilities. At a facility, privacy is a determinant of client visits and products given out per visit. Transiently, during COVID-19, client volumes decreased, with a shift from oral pills to condoms and emergency contraceptive pills.

Sexual and Reproductive Health Service Seeking Scale (SRHSSS): development, validity, and reliability

BACKGROUND

Young adults are a diverse group with diverse cares, choices and preferences in accessing and using Sexual and Reproductive Health (SRH) services, they should be at the center of the development of new managed models and solutions for the delivery of SRH services. The purpose of the study is to develop a valid and reliable measurement tool that can be used to determine the knowledge and attitudes of young adults about SRH and the barriers for accessing services, and to evaluate the attitudes and needs of young adults to receive SRH services.

METHODS

In this study, the questions of the scale were developed through literature review, focus group interview with 8 people and expert evaluation were made, and a pre-test application was also carried out. Exploratory factor analysis and reliability testing were performed with a sample of 458 young adults. The re-test reliability was performed with 220 participants who were reached one month after the first measurement. Principal component analysis was used to establish the construct validity. The reliability of the scale was assessed using the Cronbach's alpha value.

RESULTS

A 23-item scale has been developed to identify and evaluate young adults' thoughts, attitudes, and perceived barriers for accessing services regarding SRH. In the exploratory factor analysis conducted to examine the construct validity of SRHSSS, a four-factor structure was obtained that explained 89.45% of the total variance. The factor loadings of the scale items were found to vary between 0.78-0.97. At the same time, the Cronbach's alpha value of the scale is 0.90, indicates a good internal consistency.

CONCLUSIONS

SRHSSS is a scale with sufficient validity and reliability to determine young adults' SRH Service Seeking.

Utilization of family planning and associated factors among women with disabilities in ethiopia: A systematic review and meta-analysis

BACKGROUND

Persons with disabilities have a right to make their own choices about their bodies, health, and lives, especially regarding their sexual and reproductive health. But they may experience more challenges than women without disabilities in having their reproductive health needs met. So there is an urgent need to scale up disability inclusion in all levels of the health system including family planning. Therefore, the objective of this study was to estimate the pooled prevalence of Family Planning Utilization and Associated Factors among Women with Disabilities in Ethiopia.

METHODOLOGY

Studies were gathered from Pub Med/MEDLINE (681), Google Scholar (426), African Journal of Online (AJOL) (36), CINAHL (211), HINARI (191), Scopus (86), Science Direct (62), Excerpta Medica database (EMBA, SE) (113), DOAJ (38), Web of Science (26), Google (271), and other organization's websites (2) using a combination of search terms and Boolean operators. The modified Newcastle Ottawa Scale (NOS) for cross-sectional research was used by three authors to independently assess the quality of each study. For statistical analysis, STATATM Version 11 software was employed. For the meta-analysis, the random-effects (Der Simonian and Laird) technique was applied. The heterogeneity test was performed using I-squared (I2) statistics. A one-out sensitivity analysis was performed.

RESULT

A total of 7 articles with 2787 participants were included in this systematic review and meta-analysis. The pooled prevalence of family planning utilization among Women with Disabilities was 29.6% (95% CI: 22.3, 36.8); I2 = 94.6%). Women who were in marital union (p<0.001) and who had a discussion with their husbands (p = 0.007) were factors significantly associated with the utilization of family planning among women with disabilities.

CONCLUSION

The finding of this study showed that utilization of family planning among women with disability is relatively lower than the Ethiopian Demographic Health Survey 2019. Therefore, the discussions with the partner and their engagement in decisions to use family planning are critical to increase its use.

"So let me give you money, you give me what I want": decision-making priorities around contraceptive method and source choice among young women in Kenya

BACKGROUND

Many factors influence young women's choice of contraceptive methods and where to source them, yet less is known about whether one of these choices (method or source) is prioritized and the relationship between these choices. This study qualitatively explored decision-making around contraceptive method and source choice among young women in Kenya.

METHODS

In August-September 2019, 30 in-depth interviews were conducted with women ages 18-24 who had used two or more contraceptive methods and resided in three counties: Nairobi, Mombasa or Migori. Participants were recruited from public and private health facilities and pharmacies. Interview guides captured information about decision-making processes for each contraceptive method the respondent had ever used. Responses were audio-recorded, transcribed, translated into English, coded, and analyzed thematically.

RESULTS

The majority of respondents knew which method they wanted to use prior to seeking it from a source. This was true for all types of methods that women ever used. Of the small number of respondents who selected their source first, most were in the post-partum period or experiencing side effects and sought counseling at a source before choosing a method.

CONCLUSIONS

This study highlights the importance of providing young women with high quality counseling that provides full information about contraceptive options and addresses that young women's needs vary along the reproductive health continuum of care. This will ensure that young women have information to inform future contraceptive decision-making prior to seeking care.

Community perspectives on family planning service quality among users and non-users: a qualitative study from two cities in Burkina Faso

BACKGROUND

Most studies that focus on quality of family planning (FP) services collect data from facilities. These studies miss the perspectives of quality from women who do not visit a facility and for whom perceived quality may be a barrier to service utilization.

METHODS

This qualitative study from two cities in Burkina Faso examines perceived quality of FP services from women who were recruited at the community level to avoid potential biases based on recruiting women at facilities. Twenty focus group discussions were undertaken with varying groups of women of different ages (15-19; 20-24; 25+), marital statuses (unmarried; married), and current modern contraceptive use experiences (current non-users; current users). All focus group discussions were undertaken in the local language and transcribed and translated into French for coding and analysis.

RESULTS

Women discuss FP service quality in a variety of locations, depending on their age group. Perspectives on service quality for younger women are often informed by others' experiences whereas for the older women, they are formed by their own and others' experiences. Two important aspects of service delivery emerge from the discussions including interactions with providers and selected system-level aspects of service provision. Important components of provider interactions relate to (a) the initial reception from the provider, (b) the quality of counseling received, (c) stigma and bias from providers, and d) privacy and confidentiality. At the health system level, discussions revolved around (a) wait time; (b) stockouts of methods; (c) costs of services/methods; (d) the expectation for tests as part of service provision; and (e) difficulties with method removal.

CONCLUSIONS

To increase contraceptive use among women, it is crucial to address the components of service quality they identify as related to higher quality services. This means supporting providers to offer services in a more friendly and respectful manner. In addition, it is important to ensure that full information is provided to clients on what to expect during a visit to avoid false expectations that lead to poor perceived quality. These types of client-focused activities can improve perceptions of service quality and ideally support use of FP to meet women's needs.

Security, confidentiality, privacy and patient safety in the hospital information systems from the users' perspective: A cross-sectional study

INTRODUCTION

Patient safety maintenance and improvement is an expected core function of Hospital Information Systems (HISs). Patient safety can be affected by the privacy, confidentiality, and security of patient information. This study aimed to evaluate the security, confidentiality, privacy, and patient safety in the HISs from the users' perspective.

METHODS

A descriptive, analytical, cross-sectional study was conducted in five teaching hospitals affiliated with Zahedan University of Medical Sciences in 2022. The research population consisted of users of HISs in the nursing, medical records, radiology, laboratory, and pharmacy departments. The sample included 397 participants. The data were collected using a researcher-made questionnaire and analyzed with the SPSS software using descriptive (mean, standard deviation, frequency, and percentage) and analytical (Pearson, Spearman, and chi-square tests) statistics.

RESULTS

The mean score of patient information privacy, confidentiality, security, and patient safety was 3.19 ± 0.585, 2.48 ± 1.143, 2.53 ± 0.940, and 2.60 ± 0.959, respectively. Patient safety had a strong positive correlation with security and confidentiality, and a moderate positive correlation with patient information privacy (P < 0.05).

CONCLUSION

The given HISs were at a relatively desirable level in terms of information privacy, security, and patient safety and at an undesirable level concerning confidentiality from the users' perspective. Developing guidelines and regulations regarding the privacy, confidentiality, security, and patient safety of HISs, supervising their implementation by responsible agencies and departments, and educating and training healthcare professionals about these concepts are essential to improve the existing situation in HISs of the evaluated hospitals.

Exploring the Complexity of Telehealth Privacy Through a Lens of Adolescent Development

Many challenges exist related to ensuring adolescent privacy with health care providers (HCPs), and the rapid integration of telehealth visits has created additional complexities in organizing privacy for adolescents. Through interviews with adolescent patients and their parents (n = 34), this qualitative analysis aimed to explore the complicated relationship and balance of adolescent alone time with HCPs, parental presence and support, and organization of privacy in order to consider how privacy during telehealth visits may contribute to adolescents' healthy development. A framework by Blum et al. (2014) proposed four central goals of adolescent development: emotional security, engagement with learning, self-efficacy, and decision-making skills. This conceptual framework was used to outline the ways in which adolescent privacy during telehealth impacts adolescent development. Some adolescents reported that having their parents present during their telehealth visit afforded reassurance and comfort, and many parents explained that they served as a role-model during their adolescent's telehealth visit. However, other adolescents felt higher emotional security when they could establish an independent relationship with their HCP, with many describing how privacy during their telehealth visit enabled them to have more sensitive discussions with their HCP. Adolescents and parents also reported that telehealth allowed increased experiential learning for adolescents, given their proficiency with technology and ability to access their health care visits autonomously. Furthermore, the organization of privacy was complicated by a lack of understanding whose responsibility it was to facilitate alone time between the adolescent and HCP, as well as external factors such as location and quality of technology and the proximity of family members in the home. By ensuring opportunities for private healthcare encounters, both in telehealth and in-person visits, HCPs and parents can help support adolescents in achieving successful and healthy development.

Utilization of sexual and reproductive health services among young people in refugee settings in Uganda

There is a considerable high level of unmet need for reproductive health services among refugees. Yet, there is limited research about the provision and utilization of sexual and reproductive health (SRH) services among young people in refugee settings. Drawing on a sample of 575 young refugees (15-24 years) from a cross-sectional survey, this study aims to fill this gap by identifying the factors associated with SRH utilization among young people living in refugee settings in Northern Uganda. The utilization of SRH services at the health facilities was significantly different between female and male young people after adjusting for all other variables (aOR = 2.46, 95% CI, 1.58, 3.84). Young people who were not living in a marital union (aOR = 0.38, 95% CI, 0.20, 0.71), or held inequitable gender norms about services (aOR = 0.28, 95% CI, 0.12, 0.66) had about a third of the odds of utilizing SRH services. Young women with comprehensive knowledge about contraception, modern contraceptives, and HIV and STI prevention, had more than twice the odds of utilizing SRH services (aOR = 2.23, 95% CI, 2.67, 6.90). There is need to integrate social norm measurements and social norm change strategies in strategies for promoting utilization of SRH services among refugees in low-income countries especially in Uganda.

Determinants of Adolescent Reproductive Health in West Java Indonesia: A Cross-Sectional Study

The problem of adolescent reproductive health (ARH) in Indonesia is worrying, especially regarding the Triad Adolescent Reproductive Health (Triad ARH) behavior. Many factors influence ARH behavior. This cross-sectional study explores the association factors between demographic factors, knowledge, and attitudes toward ARH behavior. Six hundred and sixty-eight junior high school and senior high school students were randomly selected from five public schools in Bandung Regency, West Java, Indonesia. The questionnaire used in this study consisted of four parts, namely: (1) demographic data of respondents; (2) knowledge including 20 questions used multiple choice questions; (3) attitude with 12 questions measured using the Likert scale; and (4) behaviors with seven questions measured using Likert scale. Results showed that gender (p = 0.006), age (p = 0.031), and level of education (p = 0.006) were associated with behavior toward ARH behavior, but knowledge (p = 0.582), religion (p = 0.628), ethnic (p = 0.276), and attitude (p = 0.094) were not associated with ARH behavior. Multivariate analysis showed that only gender (p < 0.010) significantly contributed to ARH behavior. Multivariate analysis showed that gender (OR: 2.168, 95% (CI: 1.204-3.904)) significantly contributed to ARH behavior. Based on the results, it can be concluded that the gender factor influences adolescent reproductive health behavior. This study provides further evidence that to promote positive ARH behavior's among youth in West Java, Indonesia, gender should be put in place and be sustainable, using the media and the Internet and involving the collaboration of parents, teachers, and peers to improve adolescent reproductive health.