Developing an Assessment of Contraceptive Preferences in Botswana: Piloting a Novel Approach Using Best-Worst Scaling of Attributes

Introduction

To develop an attribute-based method for assessing patient contraceptive preferences in Botswana and pilot its use to explore the relationship between patient contraceptive preferences and the contraceptive methods provided or recommended to patients by clinicians.

Methods

A list of contraceptive attributes was developed with input from patients, clinicians, and other stakeholders. We assessed patient preferences for attributes of contraceptives using a discrete choice "best-worst scaling" approach and a multi-attribute decision-making method that linked patient attribute preferences to actual contraceptive method characteristics. Attribute-based patient method preferences and clinician recommendations were compared in 100 women seeking contraceptive services, and 19 clinicians who provided their care. For 41 of the patients, the short-term reliability of their preference scores was also examined.

Results

For 57 patients who wanted more children in the future, the degree of concordance between patients and clinicians was 7% when comparing the top attribute-based contraceptive preference for each woman with the clinician-provided/recommended method. When the top two model-based preferred contraceptive methods were considered, concordance was 28%. For 43 women who did not want more children, concordance was 0% when using the patient's model-based "most-preferred" method, and 14% when considering the top two methods. Assessment of the short-term reliability of preference scores yielded an intraclass correlation coefficient of 0.93.

Conclusions

A best-worst scaling assessment of attributes of contraceptives was designed and piloted in Botswana as a Contraceptive Preference Assessment Tool. The preference assessment was found to have high short-term reliability, which supports its potential use as a measurement tool. There was very low concordance between women's attribute-based contraceptive preferences and their clinician's provision/recommendations of contraceptive methods. Using such a preference assessment tool could encourage greater patient involvement and more tailored discussion in contraceptive consultations.

Experiences and preferences with sexually transmitted infection care and partner notification in Gaborone, Botswana

Partner notification and treatment are essential to sexually transmitted infection (STI) management. However, in low- and middle-income countries, half of partners do not receive treatment. A mixed methods study was conducted to explore experiences and preferences around partner notification and treatment in patients seeking STI care in Gaborone, Botswana. Thirty participants were administered a quantitative survey, followed by a semi-structured interview on partner notification, treatment, and expedited partner therapy (EPT). Among the 30 participants, 77% were female with a median age of 28 years (IQR = 24-36), 87% notified their partner, and 45% of partners requiring treatment received treatment. Partners who received a contact slip were more likely to have been treated than those who did not (75% vs. 25%). Contact slips were identified as facilitators of notification and treatment, while asymptomatic partners and limited clinic resources were identified as barriers to treatment. Few participants expressed a preference for EPT and concerns included preference for medical supervision, a belief their partner would refuse, and an inability to explain the treatment. Despite successful notification, partner treatment was modest within this population. Information for partners, provider counseling, and improved access to services may increase partner treatment. Education on STIs and treatment options may improve EPT acceptability.

Reducing Oncologic Disparities by Standardizing Cancer Care

PURPOSE

Shortages in oncology-trained health care providers pose a major challenge in low- and middle-income countries (LMICs) and contribute to delays in the diagnosis and treatment of cancer. Presently, the sole oncologist in the public sector at Princess Marina Hospital, Botswana’s largest oncology referral center, is overextended, causing medical officers to be the primary providers for patients with cancer. Medical officers do not possess formal oncology training, which can potentially lead to imprecise management and suboptimal treatment. In addition, there is no standardized patient interview process in the hematology clinic, leading to inadequately captured patient records. These realities highlight the need for the dissemination and implementation of evidence-based guidelines and intake forms to standardize the delivery of cancer care for practitioners with varying degrees of training.

METHODS

To serve as a reference for medical officers and oncologists, we reviewed clinical guidelines for the most prevalent cancers in Botswana, namely breast, cervical, prostate, colorectal, and head and neck cancer. We incorporated American Joint Committee on Cancer 8th edition staging criteria into the preexisting guidelines approved by Ministry of Health and Wellness Botswana. We further customized them on the basis of radiology, pathology, and pharmaceutical resource availability in Botswana. Finally, to streamline patient visits, we created intake forms to capture comprehensive hematology-pertinent information. As a quality improvement project, we will record the use and impact of these forms as a tool to standardize the medical records.

RESULTS

Standardized cancer care guidelines were updated and are under review by the Ministry of Health and Wellness Botswana before circulation. In addition, feedback regarding the new intake forms and their use is currently being recorded.

CONCLUSION

In low- and middle-income countries, the development of cancer-specific treatment guidelines optimizes disease management through incorporation of evidence-based, resource-adjusted recommendations for clinicians and may aid in reducing global oncologic disparities. As the next phase in the implementation of guidelines, we plan to develop quick-reference cancer pathways for use in public institutions without existing oncologic expertise.

Disparities by Sex Tracked in the 2015 National Healthcare Quality and Disparities Report: Trends across National Quality Strategy Priorities, Health Conditions, and Access Measures

INTRODUCTION

Established by the Affordable Care Act, the National Quality Strategy (NQS) is the national policy goals aimed at improving the quality of health care for all Americans. The NQS established six priorities to provide better, more affordable care for individuals and communities. This is the first analysis of data on the NQS and access measures that focus on sex differences, health conditions, trends, and disparities.

METHODS

Measures from the 2015 National Healthcare Quality and Disparities Report (QDR) for the four National Quality Strategy priorities (Patient Safety, Person Centered Care, Effective Treatment, and Healthy Living), access to care, and health conditions for women were compared to measures for men. Trends were analyzed for women by health condition and the four NQS priorities and access to care. Baseline year (2000-2002) and most current year (2012-2013) were compared to assess disparity trends. All non-institutionalized women and men in the U.S. over the age of 18 were included in the sample.

RESULTS

Disparities between males and females for the four NQS priority and access measures did not change for 83 percent of measures (n=81); disparities remained constant. The greatest improvement over time for females from the baseline year was in the patient safety measures (3.66 percent increase per year). Access of care measures showed the least amount of improvement with a median change of -1.20 percent per year. The greatest improvement in quality of care by health condition was amongst chronic kidney disease (11.95 median percent change) and HIV/AIDS (6.63 median percent change) measures. Behavioral health measures showed the least amount of improvement with a median change of -0.33 percent per year.

CONCLUSIONS

This analysis highlights cardiovascular disease, behavioral health, and access to care as problem areas for women that require immediate attention. It is of concern that 83% of the measures showed a persistent disparity over time between men and women. These results indicate that there is room for improving the quality of healthcare received by women and reducing sex-based disparities experienced by women in the healthcare delivery system.