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Gero A, Elliott S, Baayd J, Cohen S, Simmons RG, Gawron LM. Factors associated with a negative Patient Acceptable Symptom State (PASS) response with intrauterine device placement: A retrospective survey of HER Salt Lake participants. Contraception 2024; 133:110385. [PMID: 38307487 DOI: 10.1016/j.contraception.2024.110385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVES In an established cohort of HER Salt Lake Contraceptive Initiative participants with a prior intrauterine device (IUD) placement, we sought to (1) define the proportion of participants who reported a negative Patient Acceptable Symptom State (PASS) response, (2) explore factors associated with an unacceptable PASS response, and (3) identify pain management preferences for IUD placement. STUDY DESIGN A retrospective survey was sent to 1440 HER Salt Lake IUD users. A PASS question queried IUD placement pain experience acceptability. We explored associations between an unacceptable PASS response and sociodemographic, reproductive and other individual characteristics using t-tests, chi-square tests, and multivariable logistic regression. RESULTS Of those surveyed, 620 responded (43%), and 41.6% reported an unacceptable PASS response. Those with an unacceptable PASS response reported a significantly higher experienced pain level (79.2 mm vs 51.8 mm; p < 0.01) than those with an acceptable response, were more likely to have an anxiety diagnosis (47.7% vs 37.1%; p < 0.01), and have a trauma history (33.7% vs 25.1%; p = 0.02). Most patients were not offered pain control options, but 29.4% used ibuprofen and 25.3% had a support person. Regardless of PASS response, if offered, 59.0% desired numbing medication, 56.8% ibuprofen, 51% heating pad, 33.2% support person, and 31.8% anti-anxiety medication, among others. In our multivariable logistic regression model, higher pain was associated with unacceptable PASS response (OR 1.07, 95% CI 1.05-1.08; p < 0.01). CONCLUSIONS The common finding of unacceptable pain experiences with IUD placement may cause negative perceptions of an otherwise desirable method. Incorporation of the PASS response into IUD pain management studies could expand our pain experience understanding. IMPLICATIONS IUD placement resulted in unacceptable pain experiences for 41.6% of respondents. Screening for anxiety and trauma history could identify at-risk patients to individualize pain management strategies. Incorporation of the PASS into future IUD pain management studies could result in a more comprehensive, patient-centered measure of patient experiences.
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Affiliation(s)
- Alexandra Gero
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Sarah Elliott
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jami Baayd
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Susanna Cohen
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Rebecca G Simmons
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Lori M Gawron
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States.
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Weckstein TN, Simmons RG, Baayd J, Fay KE. Contraceptive Risk Events among Family Planning Specialists: a Cross Sectional Study. Res Sq 2024:rs.3.rs-4018351. [PMID: 38496677 PMCID: PMC10942565 DOI: 10.21203/rs.3.rs-4018351/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background Proponents of abortion restriction cite advancements in contraceptive technology as a reason against the need for abortion care today, most recently through oral arguments in the Supreme Court of the United States case, Dobbs v. Jackson Women's Health. However, consistent and correct use of contraception requires reproductive health literacy. Our objectives were to quantify contraceptive risk events and assess contraceptive history and preferences among a population well-equipped to evade contraceptive risks, family planning specialists following initiation of their medical training. "Risk events" are defined as reported episodes of contraceptive failure, emergency contraception use and/or unprotected or underprotected intercourse. Methods This was a cross-sectional study among current members of a professional organization of family planning specialists. Inclusion criteria included: status as a current or retired clinician, consensual penile-vaginal intercourse since the start of medical training, and personal or partner capacity to become pregnant. Descriptive statistics were performed. This study was IRB exempt. Results Among 229 respondents, 157 (69%) reported experiencing a contraceptive risk event since training. Twenty-nine (13%) respondents reported an occurrence within the last year. By category, 47% (108/229; 3 reported unknown) reported under- or unprotected intercourse, 35% (81/229) reported emergency contraception use, and 52% of participants (117/227; 2 unknown) reported known or suspected contraceptive failure. The mean number of contraceptive methods used was 3.7 (SD 1.7) out of the 13 methods listed. Almost all (97%) participants reported at least one method was not an acceptable option, with a mean of 5.6 (SD 2.7) of the 13 listed methods. Conclusions The majority of family planning specialists have experienced contraceptive risk events during times of active pregnancy prevention since their medical training. Contraceptive method change is common and most respondents were limited in the number of methods that were personally acceptable to them. Dialogue idealizing the role of contraception in minimizing or eliminating abortion need is simplistic and inaccurately represents the lived realities of pregnancy-capable individuals and their partners, including among those with exceptional contraceptive literacy and access.
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Torres E, Carter G, Gero A, Simmons RG, Sanders JN, Turok DK. Frequency of same-day contraceptive initiation, recent unprotected intercourse, and pregnancy risk: a prospective cohort study of multiple contraceptive methods. Am J Obstet Gynecol 2024:S0002-9378(24)00083-8. [PMID: 38367756 DOI: 10.1016/j.ajog.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Same-day start removes barriers to contraceptive initiation and may reduce the risk of unintended pregnancy. It may be appropriate for all contraceptive methods, but we lack data comparing methods. OBJECTIVE This study aimed to assess the frequency of same-day start with 6 contraceptive methods among new contraceptive users and describe the efficacy of same-day start in terms of first-cycle pregnancy risk overall and by each method. STUDY DESIGN Using prospective data from the HER Salt Lake Contraceptive Initiative, we identified and assessed outcomes for participants initiating a new method of contraception beyond the first 7 days of their menstrual cycle (same-day start). Enrolled participants at 4 family planning clinics in Salt Lake County, Utah between September 2015 and March 2017 received their method of choice regardless of their cycle day or recent unprotected intercourse. All participants self-reported last menstrual period data and unprotected intercourse events in the previous 2 weeks. We excluded participants who received care immediately after or within 2 weeks of abortion care. Clinical electronic health records provided information on contraceptive method initiation and use of oral emergency contraception. Participants reported pregnancy outcomes in 1-, 3-, and 6-month follow-up surveys with clinic verification to identify any pregnancy resulting from same-day initiation. The primary outcomes report the frequency of same-day start use and first-cycle pregnancy risk among same-day start users of all contraceptive methods. The secondary outcomes include frequency of and pregnancy risk in the first cycle of use among same-day start contraception users by method. We also report the frequency of unprotected intercourse within 5 days and 6 to 14 days of contraception initiation, frequency of concomitant receipt of oral emergency contraception with initiation of ongoing contraception, and pregnancy risk with these exposures. We analyzed pregnancy risk for each contraceptive method initiated on the same day and assessed the simultaneous use of oral emergency contraception. RESULTS Of the 3568 individuals enrolled, we identified most as same-day start users (n=2575/3568; 72.2%), with 1 in 8 of those reporting unprotected intercourse in the previous 5 days (n=322/2575; 12.5%) and 1 in 10 reporting unprotected intercourse 6 to 14 days before contraceptive method initiation (n=254/2575; 9.9%). We identified 11 pregnancies among same-day start users (0.4%; 95% confidence interval, 0.2-0.7), as opposed to 1 (0.1%; 95% confidence interval, 0.002-0.6) among those who initiated contraception within 7 days from the last menstrual period. Users of oral hormonal contraception and vaginal hormonal methods reported the highest first-cycle pregnancy rates (1.0-1.2). Among same-day start users, 174 (6.8%) received oral emergency contraception at enrollment in conjunction with another method. Among the same-day start users who received emergency contraception at initiation, 4 (2.3%) pregnancies were reported. CONCLUSION Same-day start is common and associated with a low pregnancy risk. Using the "any method, any-time" approach better meets contraceptive clients' needs and maintains a low risk of pregnancy.
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Affiliation(s)
- Erica Torres
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT.
| | - Gentry Carter
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
| | - Alexandra Gero
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
| | - Rebecca G Simmons
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
| | - Jessica N Sanders
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
| | - David K Turok
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
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Simmons RG, Baayd J, Tak C, Turok DK, Elliott S, Smith JD. A stakeholder-developed logic model to improve utilization of pharmacy-prescribed contraception in Utah. Implement Sci Commun 2023; 4:124. [PMID: 37821957 PMCID: PMC10565968 DOI: 10.1186/s43058-023-00503-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/17/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Currently, 20 states in the USA have passed policies allowing pharmacists to prescribe short-acting hormonal contraception, including pills, patches, and vaginal rings. Yet, utilization of these services remains limited. The purpose of this study was to (a) assess barriers and facilitators of pharmacy contraceptive dispensing among contraceptive users, pharmacists, and healthcare providers in Utah and (b) adapt and propose an evidence-based contraceptive intervention in the pharmacy environment. METHODS We conducted 6 focus groups among contraceptive users, pharmacists, and healthcare providers assessing current barriers and facilitators to pharmacy prescribing. We coded transcripts of these focus groups to the Consolidated Framework for Implementation Research, Version 2.0 (CFIR) and characterized the findings based on the Expert Recommendations for Implementing Change (ERIC) Barrier-Busting tool. Based on the CFIR findings and ERIC strategies output, we adapted an existing evidence-based intervention (a contraceptive access initiative) to the Utah pharmacy environment. We then convened a pharmacy stakeholder meeting and presented elements of an Implementation Research Logic Model and obtained feedback. We coded this feedback to the CFIR framework to finalize an Implementation Research Logic Model for a proposed implementation approach to improving contraceptive prescribing. RESULTS Initial focus group responses clustered around specific implementation barriers including financial barriers (cost for patients, as well as lack of reimbursement for pharmacist's time); lack of awareness of the service (on the part of patients, pharmacists, and health care providers); need for updated tools for contraceptive counseling and scheduling; and need for increased pharmacists education to conduct contraceptive counseling. Proposed adaptations to the existing contraceptive access intervention included development of a technology-based patient/pharmacist screener tool and a healthcare provider/pharmacist contraceptive referral network. Stakeholders identified pharmacist reimbursement as the top priority for improving utilization. CONCLUSIONS Elements of contraceptive access initiatives mapped well as proposed implementation strategies to improving utilization of contraceptive prescribing in pharmacies.
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Affiliation(s)
- Rebecca G Simmons
- University of Utah, 201 President's Circle, Salt Lake City, UT, USA.
- Division of Family Planning, Health Educators, Leaders and Innovation Complex Suite #5050, University of Utah, 30 N. Mario Capecci Dr, Salt Lake City, UT, 84112, USA.
| | - Jami Baayd
- University of Utah, 201 President's Circle, Salt Lake City, UT, USA
| | - Casey Tak
- University of Utah, 201 President's Circle, Salt Lake City, UT, USA
| | - David K Turok
- University of Utah, 201 President's Circle, Salt Lake City, UT, USA
| | - Sarah Elliott
- University of Utah, 201 President's Circle, Salt Lake City, UT, USA
| | - Justin D Smith
- University of Utah, 201 President's Circle, Salt Lake City, UT, USA
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Kaiser JE, Turok DK, Gero A, Gawron LM, Simmons RG, Sanders JN. One-year pregnancy and continuation rates after placement of levonorgestrel or copper intrauterine devices for emergency contraception: a randomized controlled trial. Am J Obstet Gynecol 2023; 228:438.e1-438.e10. [PMID: 36427600 PMCID: PMC10065890 DOI: 10.1016/j.ajog.2022.11.1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recent evidence demonstrates the effectiveness of the levonorgestrel 52-mg intrauterine device for emergency contraception vs the copper T380A intrauterine device. Of note, 1-year pregnancy and continuation rates after intrauterine device placement for emergency contraception remain understudied. OBJECTIVE This study compared 1-year pregnancy and intrauterine device continuation rates and reasons for discontinuation among emergency contraception users randomized to the levonorgestrel 52-mg intrauterine device or the copper intrauterine device. STUDY DESIGN This participant-masked, randomized noninferiority trial recruited emergency contraception individuals desiring an intrauterine device from 6 Utah family planning clinics between August 2016 and December 2019. Participants were randomized 1:1 to the levonorgestrel 52-mg intrauterine device group or the copper T380A intrauterine device group. Treatment allocation was revealed to participants at the 1-month follow-up. Trained personnel followed up the participants by phone, text, or e-mail at 5 time points in 1 year and reviewed electronic health records for pregnancy and intrauterine device continuation outcomes for both confirmation and nonresponders. We assessed the reasons for the discontinuation and used Cox proportional-hazard models, Kaplan-Meier estimates, and log-rank tests to assess differences in the continuation and pregnancy rates between the groups. RESULTS The levonorgestrel and copper intrauterine device groups included 327 and 328 participants, respectively, receiving the respective interventions. By intention-to-treat analysis at 1 year, the pregnancy rates were similar between intrauterine device types (2.8% [9/327] in levonorgestrel 52-mg intrauterine device vs 3.0% [10/328] in copper intrauterine device; risk ratio, 0.9; 95% confidence interval, 0.4-2.2; P=.82). Most pregnancies occurred in participants after intrauterine device removal, with only 1 device failure in each group. Of note, 1-year continuation rates did not differ between groups with 204 of 327 levonorgestrel 52-mg intrauterine device users (62.4%) and 183 of 328 copper T380A intrauterine device users (55.8%) continuing intrauterine device use at 1 year (risk ratio, 1.1; 95% confidence interval, 1.0-1.2; P=.09). There were differences concerning the reasons for discontinuation between intrauterine device types, with more bleeding and cramping cited among copper intrauterine device users. CONCLUSION The pregnancy rates were low and similar between intrauterine device types. Of note, 6 of 10 intrauterine device emergency contraception users continued use at 1 year. Moreover, 1-year continuation rates were similar between intrauterine device types.
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Affiliation(s)
- Jennifer E Kaiser
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT.
| | - David K Turok
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Alexandra Gero
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Lori M Gawron
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Rebecca G Simmons
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Jessica N Sanders
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
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Simmons RG, Baayd J, Waters M, Diener Z, Turok DK, Sanders JN. Assessing contraceptive use as a continuum: outcomes of a qualitative assessment of the contraceptive journey. Reprod Health 2023; 20:33. [PMID: 36793112 PMCID: PMC9930211 DOI: 10.1186/s12978-023-01573-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Contraceptive use is often a multi-decade experience for people who can become pregnant, yet few studies have assessed how this ongoing process impacts contraceptive decision-making in the context of the reproductive life course. METHODS We conducted in-depth interviews assessing the contraceptive journeys of 33 reproductive-aged people who had previously received no-cost contraception through a contraceptive initiative in Utah. We coded these interviews using modified grounded theory. RESULTS A person's contraceptive journey occurred in four phases: identification of need, method initiation, method use, and method discontinuation. Within these phases, there were five main areas of decisional influence: physiological factors, values, experiences, circumstances, and relationships. Participant stories demonstrated the ongoing and complex process of navigating contraception across these ever-changing aspects. Individuals stressed the lack of any "right" method of contraception in decision-making and advised healthcare providers to approach contraceptive conversations and provision from positions of method neutrality and whole-person perspectives. CONCLUSIONS Contraception is a unique health intervention that requires ongoing decision-making without a particular "right" answer. As such, change over time is normal, more method options are needed, and contraceptive counseling should account for a person's contraceptive journey.
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Affiliation(s)
- Rebecca G. Simmons
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Jami Baayd
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Megan Waters
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Zoë Diener
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - David K. Turok
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Jessica N. Sanders
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
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Gawron LM, Young J, Yang S, Galyean P, Callegari LS, Gero A, Simmons RG, Millar MM, Zickmund SL. Women's Health Provider Perspectives on Reproductive Services Provision in the Veterans Health Administration. South Med J 2023; 116:181-187. [PMID: 36724533 PMCID: PMC9906969 DOI: 10.14423/smj.0000000000001513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Women veterans are a fast-growing population in the Veterans Health Administration (VHA), and ensuring reproductive service availability is a VHA priority. As such, we sought to explore barriers and facilitators to VHA reproductive service provision across a catchment area from women's health providers' perspectives. METHODS We performed a mixed-methods study, including semistructured, qualitative provider interviews with a quantitative survey on training, comfort, and knowledge of reproductive services. All women's health providers and their support staff from the Salt Lake City Veterans Affairs Medical Center and nine VHA community-based outpatient clinics were asked to participate. We conducted qualitative interviews and knowledge surveys with providers and staff to explore training, care processes, and improvement opportunities in reproductive service provision. We completed descriptive analyses of all of the quantitative data and used an open, iterative process to analyze provider interviews for emergent themes. RESULTS We interviewed 15 providers (7 advanced practice nurses, 4 registered nurses, and 4 physicians) across nine sites (50% response rate). The commonly identified barriers included provider training and staffing, scheduling/referral processes, inconsistent services/supplies, and lack of veteran awareness of reproductive services. Facilitators included prior non-VHA reproductive health experience among providers, invested support staff, and the integrated VHA health system. CONCLUSIONS Addressing barriers to VHA reproductive healthcare provision may overcome reproductive service variations related to clinic location and improve reproductive health outcomes for women veterans.
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Affiliation(s)
| | | | | | | | | | - Alexandra Gero
- From the Department of Obstetrics and Gynecology, Division of Family Planning, University of Utah, Salt Lake City
| | - Rebecca G Simmons
- From the Department of Obstetrics and Gynecology, Division of Family Planning, University of Utah, Salt Lake City
| | - Morgan M Millar
- the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City
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Kaplan J, Turok DK, Gero A, Kaiser JE, Simmons RG, Fay KE. Switching and discontinuation of participant-masked randomization to a copper or levonorgestrel intrauterine device when presenting for emergency contraception. Contraception 2023; 118:109893. [PMID: 36240903 PMCID: PMC9839545 DOI: 10.1016/j.contraception.2022.09.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Examine intrauterine device (IUD) switching or discontinuation up to 6 months after participant-masked randomization to different IUDs. STUDY DESIGN Participants were randomized 1:1 to the copper T380A or levonorgestrel 52 mg IUD for emergency contraception and informed they could switch IUD type without cost at any time. RESULTS Of the 327 subjects allocated to the levonorgestrel IUD, 7 (2.1%) switched their IUD type by 6 months versus 18 (5.5%) of the 328 copper IUD users (RR: 0.4 [95% CI: 0.2, 0.9], p = 0.03). Six-month IUD discontinuation occurred in 34 (10.4%) levonorgestrel and 35 (10.7%) copper IUD users. CONCLUSION Individuals randomly assigned to IUD type at presentation for emergency contraception continue their assigned IUDs at high rates over 6 months. IMPLICATIONS While many recruited individuals declined enrollment, those who accepted randomization had high continuation rates; the high continuation and low cross-over supports using IUD randomization as a tool for future investigation. Participants' similar rates of and reasons for switching and discontinuation by IUD type over the study period may impact clinical counseling.
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Affiliation(s)
- Jessica Kaplan
- Southwest Medical Group Women's & Family Health, Cortez, CO, United States
| | - David K Turok
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Alexandra Gero
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jennifer E Kaiser
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Rebecca G Simmons
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Kathryn E Fay
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, United States.
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Simmons RG, Baayd J, Elliott S, Cohen SR, Turok DK. Improving access to highly effective emergency contraception: an assessment of barriers and facilitators to integrating the levonorgestrel IUD as emergency contraception using two applications of the Consolidated Framework for Implementation Research. Implement Sci Commun 2022; 3:129. [PMID: 36494859 PMCID: PMC9737706 DOI: 10.1186/s43058-022-00377-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Emergency contraception prevents unwanted pregnancy after sexual intercourse. New evidence has demonstrated that the levonorgestrel 52 mg IUD is a highly effective method of emergency contraception. However, translating this research finding into clinical practice faces existing barriers to IUD access, including costs and provider training, novel barriers of providing IUDs for emergency contraception at unscheduled appointments. The purpose of this study was to identify barriers and facilitators to the utilization of the levonorgestrel IUD as emergency contraception from client, provider, and health systems perspectives. METHODS We conducted English and Spanish-speaking focus groups (n=5) of both contraceptive users (n=22) and providers (n=13) to examine how the levonorgestrel IUD as EC was perceived and understood by these populations and to determine barriers and facilitators of utilization. We used findings from our focus groups to design a high-fidelity in-situ simulation scenario around EC that we pilot tested with clinical teams in three settings (a county health department, a community clinic, and a midwifery clinic), to further explore structural and health systems barriers to care. Simulation scenarios examined health system barriers to the provision of the levonorgestrel IUD as EC. We coded both focus groups and in-clinic simulations using the modified Consolidated Framework for Implementation Research (CFIR). We then applied our findings to the CFIR-Expert Recommendations for Implementing Change (ERIC) Barrier Busting Tool and mapped results to implement recommendations provided by participants. RESULTS Ultimately, 9 constructs from the CFIR were consistently identified across focus groups and simulations. Main barriers included suboptimal knowledge and acceptability of the intervention itself, appropriately addressing knowledge and education needs among both providers and contraceptive clients, and adequately accounting for structural barriers inherent in the health system. The CFIR-ERIC Barrier Busting Tool identified eight strategies to improve levonorgestrel IUD as EC access: identifying implementation champions, conducting educational meetings, preparing educational toolkits, involving patients and their partners in implementation, conducting a local needs assessment, distributing educational materials, and obtaining patient feedback. CONCLUSIONS To sustainably incorporate the levonorgestrel IUD as EC into clinical practice, education, health systems strengthening, and policy changes will be necessary.
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Affiliation(s)
- Rebecca G. Simmons
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Jami Baayd
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Sarah Elliott
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Susanna R. Cohen
- LIFT Simulation Design Lab, Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - David K. Turok
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
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Gero A, Elliott S, Sanders JN, Turok DK, Simmons RG. P099Statewide changes in service trends at utah title x clinics around the domestic gag rule, 2017–2021. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Fay KE, Corry S, Simmons RG, Baayd J. Coerced Choice: Resigned Contraceptive Usership Among Individuals Affected by Reproductive Coercion. J Midwifery Womens Health 2022; 67:593-597. [PMID: 35861284 PMCID: PMC9561046 DOI: 10.1111/jmwh.13396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 05/14/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Partner-mediated reproductive coercion is a common form of violence that affects individuals' sexual and reproductive health goals. Clinicians' understanding of the scope of reproductive coercion continues to grow with direct implications for clinical interventions. The purpose of this study was to generate a more comprehensive set of reproductive coercion tactics used by intimate partners for recognition in a clinical setting. METHODS This was a qualitative study using grounded theory. Individuals were recruited through an established statewide community network to participate in videoconferencing focus groups regarding reproductive coercion. Discussions were moderated and recorded. Data were coded and then subjected to qualitative content analysis. RESULTS Twenty community members participated. Participants described partner interference with reproductive and sexual health goals, including limitation of their contraceptive options. Although participants were able to access health care and use contraception as part of a goal to avoid pregnancy, they also reported dissatisfaction with their methods. Some participants described being forced to use an undesired form of contraception in the setting of reproductive coercion from abusive partners. DISCUSSION Individuals affected by reproductive coercion may be able to access and exercise limited choice over their contraceptive options, but some may be unable to use the preferred method because of partners' behavior. Clinician awareness of the diversity of presentations of reproductive coercion, including individuals using long-acting reversible contraceptives, may facilitate individualized counseling and realignment of care with patient preferences.
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Affiliation(s)
- Kathryn E Fay
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Summer Corry
- College of Science, Utah Valley University, Orem, Utah
| | - Rebecca G Simmons
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jami Baayd
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
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Gero A, Simmons RG, Sanders JN, Turok DK. Does access to no-cost contraception change method selection among individuals who report difficulty paying for health-related care? BMC Womens Health 2022; 22:327. [PMID: 35918666 PMCID: PMC9344653 DOI: 10.1186/s12905-022-01911-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Out-of-pocket costs continue to be a barrier to accessing necessary healthcare services, including contraception. We explored how eliminating out-of-pocket cost affects contraceptive method choice among people reporting difficulty paying for healthcare in the previous year, and whether method satisfaction differed by method choice. METHODS We used data from the HER Salt Lake Contraceptive Initiative. This prospective cohort study provided participants with no-cost contraception (April 2016-March 2017) following a control period that provided no reduction in cost for the contraceptive implant, a reduced price for the hormonal IUD, and a sliding scale that decreased to no-cost for the copper IUD (September 2015-March 2016). We restricted the study population to those who reported difficulty paying for healthcare in the past 12 months. For our primary outcome assessing changes in method selection between intervention and control periods, we ran simultaneous multivariable logistic regression models for each method, applying test corrections for multiple comparisons. Among participants who continued their method for 1 year, we explored differences in method satisfaction using multivariable logistic regression. RESULTS Of the 1,029 participants reporting difficulty paying for healthcare and controlling for other factors, participants more frequently selected the implant (aOR 6.0, 95% CI 2.7, 13.2) and the hormonal IUD (aOR 3.2, 95% CI 1.7, 5.9) during the intervention than control period. Comparing the same periods, participants less frequently chose the injection (aOR 0.5, 95% CI 0.3, 0.8) and the pill (aOR 0.4, 95% CI 0.3, 0.6). We did not observe a difference in uptake of the copper IUD (aOR 2.0, 95% CI 1.0, 4.1).Contraceptive satisfaction scores differed minimally by contraceptive method used among contraceptive continuers (n = 534). Those who selected LNG IUDs were less likely to report low satisfaction with their method (aOR 0.5, 95% CI 0.3, 0.97). CONCLUSION With costs removed, participants who reported difficulty paying for healthcare were more likely to select hormonal IUDs and implants and less likely to select the injectable or contraceptive pills. Among continuers, there were few differences in method satisfaction. CLINICALTRIALS gov Identifier NCT02734199.
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Affiliation(s)
- Alexandra Gero
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30N 1900E Rm 2B-200, Salt Lake City, UT, 84132, USA.
| | - Rebecca G Simmons
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30N 1900E Rm 2B-200, Salt Lake City, UT, 84132, USA
| | - Jessica N Sanders
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30N 1900E Rm 2B-200, Salt Lake City, UT, 84132, USA
| | - David K Turok
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30N 1900E Rm 2B-200, Salt Lake City, UT, 84132, USA
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Simmons RG, Baayd J, Gero A, Quade C, Mullholand M, Torres E, Turok DK, Sanders JN. Implementation and Monitoring of the Family Planning Elevated Contraceptive Access Program, Utah, 2018‒2019. Am J Public Health 2022; 112:S528-S531. [PMID: 35767785 PMCID: PMC10461487 DOI: 10.2105/ajph.2022.306935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/04/2022]
Abstract
Family Planning Elevated (FPE) is a contraceptive access initiative in Utah. FPE designed and utilized a comprehensive monitoring system to identify and respond to challenges implementing our initiative as they arose. Here, we describe the components of our monitoring system, and highlight how FPE's monitoring system successfully identified that Utah's Medicaid expansion was not widely adopted by eligible individuals. We then describe how FPE adapted to this challenge. (Am J Public Health. 2022;112(S5):S528-S531. https://doi.org/10.2105/AJPH.2022.306935).
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Affiliation(s)
- Rebecca G Simmons
- All authors are affiliated with the Division of Family Planning in the Department of Obstetrics and Gynecology, at the University of Utah, Salt Lake City
| | - Jami Baayd
- All authors are affiliated with the Division of Family Planning in the Department of Obstetrics and Gynecology, at the University of Utah, Salt Lake City
| | - Alexandra Gero
- All authors are affiliated with the Division of Family Planning in the Department of Obstetrics and Gynecology, at the University of Utah, Salt Lake City
| | - Caitlin Quade
- All authors are affiliated with the Division of Family Planning in the Department of Obstetrics and Gynecology, at the University of Utah, Salt Lake City
| | - Madeline Mullholand
- All authors are affiliated with the Division of Family Planning in the Department of Obstetrics and Gynecology, at the University of Utah, Salt Lake City
| | - Erica Torres
- All authors are affiliated with the Division of Family Planning in the Department of Obstetrics and Gynecology, at the University of Utah, Salt Lake City
| | - David K Turok
- All authors are affiliated with the Division of Family Planning in the Department of Obstetrics and Gynecology, at the University of Utah, Salt Lake City
| | - Jessica N Sanders
- All authors are affiliated with the Division of Family Planning in the Department of Obstetrics and Gynecology, at the University of Utah, Salt Lake City
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Thorman A, Engle A, Brintz B, Simmons RG, Sanders JN, Gawron LM, Turok DK, Kaiser JE. Quantitative and qualitative impact of One Key Question on primary care providers' contraceptive counseling at routine preventive health visits. Contraception 2022; 109:73-79. [PMID: 35038448 PMCID: PMC9258909 DOI: 10.1016/j.contraception.2022.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES One Key Question (OKQ) is a clinical screening tool to assess pregnancy desire in the next year. We aimed to 1) describe the effect of OKQ implementation on contraceptive counseling rates at preventive health visits and 2) evaluate primary care providers' perception of OKQ implementation on their contraceptive counseling practices. STUDY DESIGN We performed a quantitative retrospective chart review of preventive health visits at eight federally qualified health centers in Utah between 2014 and 2017. Implementation of OKQ included a brief training and inclusion of OKQ in the electronic medical record. Providers received OKQ training in August 2015 and re-training in March 2017. We assessed OKQ and contraceptive counseling documentation rates using interrupted-time-series analysis. We then conducted semi-structured interviews with providers and queried them about the impact of OKQ. We identified dominant themes using modified grounded theory to create an explanatory framework. RESULTS Abstracting 6634 charts yielded 9840 visits with 56 unique providers (51% physician assistant, 34% physician, 14% nurse practitioner). Interrupted-time-series analysis showed a documentation increase of OKQ in late 2015 (2.6%) and again in spring 2017 (9%), however rates remained low. Contraceptive counseling rates (39.7%) did not change after OKQ implementation. Charts with evidence of a current contraceptive method were less likely to have a OKQ response documented. Interviewees reported OKQ's algorithm did not alter their contraceptive counseling. CONCLUSIONS OKQ did not change documented rates of contraceptive counseling and uptake was low in quantitative and qualitative analyses. Our study suggests limited usefulness of OKQ in the primary care setting. IMPLICATIONS Implementation of the One Key Question tool through training and optional EHR field did not increase documented rates of contraceptive counseling in a large federally qualified health center or affect provider contraceptive counseling. Our study suggests limited usefulness of OKQ as a robust screening tool in this primary care setting.
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Affiliation(s)
- Alyssa Thorman
- University of Utah, School of Medicine, Salt Lake City, UT, United States
| | - Alyssa Engle
- University of Utah, School of Medicine, Salt Lake City, UT, United States
| | - Benjamin Brintz
- University of Utah, Study Design and Biostatistics Center, Salt Lake City, UT, United States
| | - Rebecca G Simmons
- University of Utah, Division of Family Planning, Salt Lake City, UT, United States
| | - Jessica N Sanders
- University of Utah, Division of Family Planning, Salt Lake City, UT, United States
| | - Lori M Gawron
- University of Utah, Division of Family Planning, Salt Lake City, UT, United States
| | - David K Turok
- University of Utah, Division of Family Planning, Salt Lake City, UT, United States
| | - Jennifer E Kaiser
- University of Utah, Division of Family Planning, Salt Lake City, UT, United States.
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Kaiser JE, Galindo E, Sanders JN, Simmons RG, Gawron LM, Herrick JS, Brintz B, Turok DK. Determining the impact of the Zika pandemic on primary care providers' contraceptive counseling of non-pregnant patients in the US: a mixed methods study. BMC Health Serv Res 2021; 21:1215. [PMID: 34753479 PMCID: PMC8579600 DOI: 10.1186/s12913-021-07170-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/12/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Global pandemics like Zika (ZIKV) factor into pregnancy planning and avoidance, yet little is known about how primary care providers (PCPs) incorporate public health guidance into contraceptive counseling. Study objectives include: 1) determining the impact of the ZIKV pandemic on contraceptive counseling changes; and 2) assessing PCP knowledge and practice regarding contraception, ZIKV, and CDC ZIKV guidelines. METHODS Study components included: (1) a retrospective review of electronic health records of non-pregnant, reproductive age women presenting for preventive health visits between 2014 and 2017 assessed using interrupted time series analyses (ITSA) to identify changes in documentation of ZIKV risk assessment and contraceptive counseling; and (2) a sequential, cross-sectional study with quantitative surveys and qualitative, semi-structured interviews of PCPs providing preventive care to non-pregnant patients at eight federally qualified health centers in Utah. We performed descriptive analyses on survey data and analyzed qualitative data for dominant themes using a modified Health Belief Model. RESULTS We conducted 6634 chart reviews yielding 9840 visits. The ITSA did not reveal changes in ZIKV risk assessment or contraceptive counseling. Twenty-two out of 40 (55%) eligible providers participated in the provider component. Participants averaged 69 and 81% correct on contraceptive and ZIKV knowledge questions, respectively. Sixty-five percent reported counseling consistent with CDC ZIKV guidelines. Qualitative analysis found providers unlikely to prioritize ZIKV risk assessment in contraceptive counseling for non-pregnant patients. CONCLUSIONS PCPs who care for non-pregnant women are knowledgeable about contraception and ZIKV; however, there was no change in ZIKV risk assessment or contraceptive counseling. This stresses the importance of developing strategies to improve guideline uptake.
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Affiliation(s)
- Jennifer E Kaiser
- University of Utah, Division of Family Planning, 50 North Medical Drive, Salt Lake City, UT, 84132, USA.
| | - Eduardo Galindo
- University of Utah, Division of Family Planning, 50 North Medical Drive, Salt Lake City, UT, 84132, USA
| | - Jessica N Sanders
- University of Utah, Division of Family Planning, 50 North Medical Drive, Salt Lake City, UT, 84132, USA
| | - Rebecca G Simmons
- University of Utah, Division of Family Planning, 50 North Medical Drive, Salt Lake City, UT, 84132, USA
| | - Lori M Gawron
- University of Utah, Division of Family Planning, 50 North Medical Drive, Salt Lake City, UT, 84132, USA
| | - Jennifer S Herrick
- University of Utah, Study Design and Biostatistics Center, 295 Chipeta Way, Salt Lake City, UT, 84122, USA
| | - Benjamin Brintz
- University of Utah, Study Design and Biostatistics Center, 295 Chipeta Way, Salt Lake City, UT, 84122, USA
| | - David K Turok
- University of Utah, Division of Family Planning, 50 North Medical Drive, Salt Lake City, UT, 84132, USA
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Simmons RG, Gero A, Geist C, Sanders JN. POSTER ABSTRACTS. Contraception 2021. [PMCID: PMC8421003 DOI: 10.1016/j.contraception.2021.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Torres E, Gero A, Simmons RG, Sanders JN, Clement A, Turok DK. POSTER ABSTRACTS. Contraception 2021. [DOI: 10.1016/j.contraception.2021.07.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gawron LM, Simonsen S, Millar MM, Lewis-Caporal J, Patel S, Simmons RG. Pregnancy Risk Screening and Counseling for Women Veterans: Piloting the One Key Question in the Veterans Healthcare Administration. South Med J 2021; 114:150-155. [PMID: 33655308 DOI: 10.14423/smj.0000000000001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Women veterans have a high prevalence of comorbidities that increase the risk of adverse pregnancy outcomes. Screening for pregnancy desires in primary care provider (PCP) visits offers an opportunity to optimize preconception health. This pilot quality improvement initiative sought to assess Veterans Healthcare Administration provider preferences on One Key Question (OKQ) implementation, identification of veterans' reproductive needs, and the effect of training on documentation in a women's primary care clinic in Salt Lake City, Utah. METHODS We hosted OKQ training sessions for providers and staff, audio recorded group discussions on implementation barriers, and explored themes. Women veterans presenting for a PCP visit in July 2018 self-completed a paper OKQ screening tool. We calculated summary statistics on responses. We conducted a pre-post analysis, with respect to training sessions, to measure for changes in family planning documentation during PCP visits. RESULTS Nineteen providers and staff completed the training. They acknowledged the importance, but believed that the screening tool should be completed by veterans and not be provider prompted. Forty-two women veterans completed the screening tool: 21% desired pregnancy in the next year and 26% desired contraceptive information. Chart reviews found a nonsignificant increase in current contraceptive method documentation between periods (20% vs 37%; P = 0.08), a decline in documentation of reproductive goals (22% vs 3%; P = 0.02), and no significant change in counseling. CONCLUSIONS Veterans identify reproductive needs via the OKQ screening tool, but provider documentation did not reflect changes in care following training. Further study is necessary to develop an optimal, patient-centered tool and implementation plan to support women veterans in their reproductive goals.
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Affiliation(s)
- Lori M Gawron
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
| | - Sara Simonsen
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
| | - Morgan M Millar
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
| | - Jessica Lewis-Caporal
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
| | - Shardool Patel
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
| | - Rebecca G Simmons
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
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Sexsmith CD, Sanders JN, Simmons RG, Dalessandro C, Turok DK. Contraceptive Method Uptake at Title X Health Centers in Utah. Womens Health Issues 2021; 31:219-226. [PMID: 33750676 DOI: 10.1016/j.whi.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 01/12/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Title X family planning program previously supported contraception for Utah clients with low incomes, yet its contributions may not have been sufficient to allow clients to select their preferred methods, including long-acting reversible contraceptives (LARCs). In this study, we compare the contraceptive method choices of self-paying clients with low incomes at three participating Title X health centers in Salt Lake County, Utah, before and after the removal of additional cost barriers. METHODS We used retrospective medical record review to assess clients' contraceptive choices during two 6-month periods: a control period with Title X-assisted sliding scale payment schedules (n = 2,776) and an intervention period offering no-cost contraceptive care (n = 2,065). We used logistic regression to identify the likelihood of selecting a LARC during the intervention period and multinomial regression to identify the selection probability of different types of available LARCs. RESULTS During the control period, 16% of participants chose a LARC compared with 26% in the intervention period (p ≤ .001). During the intervention period, participants were 1.8 times more likely to select LARCs (95% confidence interval, 1.65-2.13) compared with non-LARC methods, holding covariates constant. In the multinomial regression, participants were three times more likely during the intervention period to select an implant than a pill, patch, or ring, holding all other covariates constant (odds ratio, 3.08; 95% confidence interval, 2.47-3.83). CONCLUSIONS Title X clients offered contraceptive methods without cost more frequently selected a LARC method. Title X funding reductions may impede individuals' access to their contraceptive methods of choice.
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Affiliation(s)
- Corinne D Sexsmith
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jessica N Sanders
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Rebecca G Simmons
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Cristen Dalessandro
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah.
| | - David K Turok
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
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Turok DK, Gero A, Simmons RG, Kaiser JE, Stoddard GJ, Sexsmith CD, Gawron LM, Sanders JN. Levonorgestrel vs. Copper Intrauterine Devices for Emergency Contraception. N Engl J Med 2021; 384:335-344. [PMID: 33503342 PMCID: PMC7983017 DOI: 10.1056/nejmoa2022141] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In the United States, more intrauterine device (IUD) users select levonorgestrel IUDs than copper IUDs for long-term contraception. Currently, clinicians offer only copper IUDs for emergency contraception because data are lacking on the efficacy of the levonorgestrel IUD for this purpose. METHODS This randomized noninferiority trial, in which participants were unaware of the group assignments, was conducted at six clinics in Utah and included women who sought emergency contraception after at least one episode of unprotected intercourse within 5 days before presentation and agreed to placement of an IUD. We randomly assigned participants in a 1:1 ratio to receive a levonorgestrel 52-mg IUD or a copper T380A IUD. The primary outcome was a positive urine pregnancy test 1 month after IUD insertion. When a 1-month urine pregnancy test was unavailable, we used survey and health record data to determine pregnancy status. The prespecified noninferiority margin was 2.5 percentage points. RESULTS Among the 355 participants randomly assigned to receive levonorgestrel IUDs and 356 assigned to receive copper IUDs, 317 and 321, respectively, received the interventions and provided 1-month outcome data. Of these, 290 in the levonorgestrel group and 300 in the copper IUD group had a 1-month urine pregnancy test. In the modified intention-to-treat and per-protocol analyses, pregnancy rates were 1 in 317 (0.3%; 95% confidence interval [CI], 0.01 to 1.7) in the levonorgestrel group and 0 in 321 (0%; 95% CI, 0 to 1.1) in the copper IUD group; the between-group absolute difference in both analyses was 0.3 percentage points (95% CI, -0.9 to 1.8), consistent with the noninferiority of the levonorgestrel IUD to the copper IUD. Adverse events resulting in participants seeking medical care in the first month after IUD placement occurred in 5.2% of participants in the levonorgestrel IUD group and 4.9% of those in the copper IUD group. CONCLUSIONS The levonorgestrel IUD was noninferior to the copper IUD for emergency contraception. (Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others; ClinicalTrials.gov number, NCT02175030.).
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Affiliation(s)
- David K Turok
- From the Division of Family Planning, Department of Obstetrics and Gynecology (D.K.T., A.G., R.G.S., J.E.K., C.D.S., L.M.G., J.N.S.), and the Division of Epidemiology, Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City
| | - Alexandra Gero
- From the Division of Family Planning, Department of Obstetrics and Gynecology (D.K.T., A.G., R.G.S., J.E.K., C.D.S., L.M.G., J.N.S.), and the Division of Epidemiology, Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City
| | - Rebecca G Simmons
- From the Division of Family Planning, Department of Obstetrics and Gynecology (D.K.T., A.G., R.G.S., J.E.K., C.D.S., L.M.G., J.N.S.), and the Division of Epidemiology, Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City
| | - Jennifer E Kaiser
- From the Division of Family Planning, Department of Obstetrics and Gynecology (D.K.T., A.G., R.G.S., J.E.K., C.D.S., L.M.G., J.N.S.), and the Division of Epidemiology, Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City
| | - Gregory J Stoddard
- From the Division of Family Planning, Department of Obstetrics and Gynecology (D.K.T., A.G., R.G.S., J.E.K., C.D.S., L.M.G., J.N.S.), and the Division of Epidemiology, Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City
| | - Corinne D Sexsmith
- From the Division of Family Planning, Department of Obstetrics and Gynecology (D.K.T., A.G., R.G.S., J.E.K., C.D.S., L.M.G., J.N.S.), and the Division of Epidemiology, Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City
| | - Lori M Gawron
- From the Division of Family Planning, Department of Obstetrics and Gynecology (D.K.T., A.G., R.G.S., J.E.K., C.D.S., L.M.G., J.N.S.), and the Division of Epidemiology, Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City
| | - Jessica N Sanders
- From the Division of Family Planning, Department of Obstetrics and Gynecology (D.K.T., A.G., R.G.S., J.E.K., C.D.S., L.M.G., J.N.S.), and the Division of Epidemiology, Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City
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Hopelian NG, Simmons RG, Sanders JN, Ward K, Jenkins SM, Espey E, Turok DK. Comparison of levonorgestrel level and creamatocrit in milk following immediate versus delayed postpartum placement of the levonorgestrel IUD. BMC Womens Health 2021; 21:33. [PMID: 33478494 PMCID: PMC7818753 DOI: 10.1186/s12905-021-01179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/13/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Breastfeeding and postpartum contraception critically influence infant and maternal health outcomes. In this pilot study, we explore the effects of timing and duration of postpartum levonorgestrel exposure on milk lipid and levonorgestrel content to establish baseline data for future research. METHODS This sub-study recruited a balanced convenience sample from 259 participants enrolled in a parent randomized controlled trial comparing immediate to delayed (4-8 weeks) postpartum levonorgestrel IUD placement. All planned to breastfeed, self-selected for sub-study participation, and provided the first sample at 4-8 weeks postpartum (before IUD placement for the delayed group) and the second four weeks later. We used the Wilcoxon rank sum (inter-group) and signed rank (intra-group) tests to compare milk lipid content (creamatocrit) and levonorgestrel levels between groups and time points. RESULTS We recruited 15 participants from the immediate group and 17 from the delayed group with 10 and 12, respectively, providing both early and late samples. Initially, median levonorgestrel concentration of the immediate group (n = 10) (32.5 pg/mL, IQR: 24.8, 59.4) exceeded that of the delayed group (n = 12) (17.5 pg/mL, IQR: 0.0, 25.8) (p = 0.01). Four weeks later, the values aligned: 26.2 pg/mL (IQR: 20.3, 37.3) vs. 28.0 pg/mL (IQR: 25.2, 40.8). Creamatocrits were similar between both groups and timepoints. CONCLUSIONS Immediate postpartum levonorgestrel IUD placement results in steady, low levels of levonorgestrel in milk without apparent effects on lipid content. These findings provide initial support for the safety of immediate postpartum levonorgestrel IUD initiation, though the study was not powered to detect noninferiority between groups. TRIAL REGISTRATION This randomized controlled trial was registered with ClinicalTrials.gov (Registry No. NCT01990703) on November 21, 2013.
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Affiliation(s)
- Niaree G. Hopelian
- The University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT 84132 USA
- Present Address: Department of Psychiatry, Neuropsychiatric Institute, University of Illinois, Chicago, 912 S Wood St, Chicago, IL 60612 USA
| | - Rebecca G. Simmons
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT 84132 USA
| | - Jessica N. Sanders
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT 84132 USA
| | - Katherine Ward
- The University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112 USA
| | - Sabrina Malone Jenkins
- Division of Neonatology, Department of Pediatrics, The University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108 USA
| | - Eve Espey
- Department of Obstetrics and Gynecology, The University of New Mexico School of Medicine, Albuquerque, NM 87131 USA
| | - David K. Turok
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT 84132 USA
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Baayd J, Simmons RG. Protocol for a process evaluation of Family Planning Elevated: a statewide initiative to improve contraceptive access in Utah (USA). BMJ Open 2020; 10:e038049. [PMID: 33004395 PMCID: PMC7534679 DOI: 10.1136/bmjopen-2020-038049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/18/2020] [Accepted: 08/28/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Many individuals in the USA do not have access to the contraceptive methods they desire. Contraceptive initiatives have emerged at the state and national levels to remove barriers to access, and many initiatives have reported success. Other initiatives may want to build on or replicate that success, but data are scarce on the details of how and why certain interventions work. This paper describes the protocol for the planned process evaluation of Family Planning Elevated (FPE), a statewide contraceptive initiative in Utah. METHODS FPE will conduct a process evaluation during the planning and implementation phases of the programme. The process evaluation will document (1) the community, state and national contexts in which the programme is implemented, (2) how FPE is implemented and (3) the mechanism by which FPE creates impact. We will collect qualitative data via interviews with FPE staff, providers and staff participating in the programme, and key stakeholders and policy-makers throughout the state. The team process evaluator will record FPE decision making and implementation activities by taking field notes during weekly FPE meetings. Quantitatively, we will collect monthly data reports from FPE-participating clinics, analytics reports from the media campaign and survey results from patients in FPE-participating clinics. The findings of the process evaluation will allow other contraceptive initiatives to learn from FPE's efforts and replicate successful components of the programme. ETHICS AND DISSEMINATION The study received approval from the University of Utah's Institutional Review Board. Findings from the process evaluation and outcome evaluation will be published, shared with other contraceptive initiatives and presented at conferences. TRIAL REGISTRATION NUMBER NCT03877757.
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Affiliation(s)
- Jami Baayd
- Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, USA
| | - Rebecca G Simmons
- Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, USA
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Simmons RG, Jennings V. Fertility awareness-based methods of family planning. Best Pract Res Clin Obstet Gynaecol 2020; 66:68-82. [DOI: 10.1016/j.bpobgyn.2019.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
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Gawron LM, Simmons RG, Sanders JN, Myers K, Gundlapalli AV, Turok DK. The effect of a no-cost contraceptive initiative on method selection by women with housing insecurity. Contraception 2020; 101:205-209. [PMID: 31881219 PMCID: PMC7054141 DOI: 10.1016/j.contraception.2019.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 09/25/2019] [Accepted: 11/13/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To compare the sociodemographic characteristics of participants in a contraceptive initiative by housing security and determine the association between housing insecurity on contraceptive method selection before and after the removal of cost. STUDY DESIGN This cross-sectional assessment includes 4,327 reproductive-aged participants in the HER Salt Lake Contraceptive Initiative who sought new contraceptive services and reported housing status at enrollment. HER Salt Lake prospectively explored the impact of improved contraceptive access on socioeconomic outcomes in Salt Lake County (USA). For six months (September 2015-March 2016) we collected control data, which included clinic standard-of-care cost-sharing. The intervention started March 2016, and provided no-cost contraception services and unlimited opportunities for method switching over the subsequent three years. RESULTS There were 964 (22%) housing-insecure participants. Compared to those with stable housing, housing-insecure individuals more commonly identified as a sexual minority, received public assistance and lacked health insurance. Housing-insecure women preferentially selected long-acting reversible contraception during the control period (aOR 1.60; 95%CI 1.01-2.56), but method selection equalized across housing status during the intervention. CONCLUSIONS When cost is not a barrier, all women desire a comprehensive selection of contraceptive methods, regardless of housing security. Contraceptive clients in this vulnerable population need interventions which address access barriers to all methods to support reproductive planning. IMPLICATIONS Unintended pregnancy during housing insecurity may result in homelessness. This study found housing-insecure women desire access to all contraceptive methods, not just long acting reversible contraception. Integration of comprehensive family planning initiatives into efforts to address homelessness is essential to support this vulnerable population in their reproductive planning.
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Affiliation(s)
- Lori M Gawron
- Department of Obstetrics and Gynecology, University of Utah School of Medicine.
| | - Rebecca G Simmons
- Department of Obstetrics and Gynecology, University of Utah School of Medicine.
| | - Jessica N Sanders
- Department of Obstetrics and Gynecology, University of Utah School of Medicine.
| | - Kyl Myers
- Department of Obstetrics and Gynecology, University of Utah School of Medicine.
| | - Adi V Gundlapalli
- Department of Internal Medicine, University of Utah School of Medicine and VA Salt Lake City Health Care System.
| | - David K Turok
- Department of Obstetrics and Gynecology, University of Utah School of Medicine.
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Simmons RG, Sanders JN, Geist C, Gawron L, Myers K, Turok DK. Predictors of contraceptive switching and discontinuation within the first 6 months of use among Highly Effective Reversible Contraceptive Initiative Salt Lake study participants. Am J Obstet Gynecol 2019; 220:376.e1-376.e12. [PMID: 30576664 PMCID: PMC6861011 DOI: 10.1016/j.ajog.2018.12.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/30/2018] [Accepted: 12/12/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Nearly half of women will switch or discontinue using their selected contraceptive method in the first year. Research on early switching or discontinuation provides important clinical and public health insights, although few studies have assessed associated factors, particularly among longitudinal cohorts. OBJECTIVE The current study explores attributes associated with early contraceptive method switching or discontinuation (<6 months of initiation) among participants enrolled in the intervention cohorts of the Highly Effective Reversible Contraceptive Initiative Salt Lake Contraceptive Initiative (Utah, United States). MATERIALS AND METHODS Highly Effective Reversible Contraceptive Initiative Salt Lake participants have access to no-cost contraception for 3 years. This includes both the initial selection and the ability to switch or to discontinue methods without cost. Methods available included the following: nonhormonal behavioral methods (male/female condoms, withdrawal, diaphragms, cervical caps, and fertility awareness); short-acting methods (pill, patch, ring, and injectable); and long-acting methods (intrauterine devices and contraceptive implants). Participants completed surveys at baseline and at 1, 3, and 6 months. We collected data on participant demographics, contraceptive continuation, switching, and discontinuation, as well as factors associated with these changes, including established measures of pregnancy intention and ambivalence and reasons for switching or discontinuing. We conducted descriptive statistics, univariable, and multivariable Poisson regression analyses to assess predictors of both discontinuation and switching. We also conducted χ2 analyses to compare reported reasons for stopping between switchers and discontinuers. RESULTS At 6 months, 2,583 women (70.0%) reported continuation of their baseline method, 367 (10%) reported at least 1 period of discontinuation, 459 (12.4%) reported switching to a different method, and 279 (7.6%) did not provide 6-month follow-up. Factors associated with discontinuation included selection of a short-acting method (incidence rate ratio [IRR], 2.49; 95% confidence interval [CI], 1.97, 3.12), report of Hispanic ethnicity (IRR, 1.45; 95% CI, 1.12, 1.89) and nonwhite race (IRR, 1.48; 95% CI, 1.08, 2.02), and having any future pregnancy plans, even years out. Participants with some college education were less likely to report discontinuation (IRR, 0.73; 95% CI, 0.57, 0.94). Selecting a short-acting method at baseline was also associated with increased likelihood of method switching (IRR, 2.29, 95% CI, 1.87, 2.80), as was having 2 or more children (IRR, 1.37; 95% CI, 1.08, 1.74). Women were less likely to switch if they were on their parents' insurance (IRR, 0.74; 95% CI, 0.56, 0.99). Among participants who switched methods, 36.9% switched to a long-acting reversible method, 31.7% switched to a short-acting hormonal method, and 31.1% switched to a nonhormonal behavioral method, such as condom use. Of participants providing a reason for stopping, 454 women (73.2%) reported side effects as 1 reason for switching or discontinuing their initial method. CONCLUSION Early contraceptive method switching and discontinuation are frequent outcomes of contraceptive use. These changes are common even with removal of contraceptive access barriers.
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Affiliation(s)
- Rebecca G Simmons
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT.
| | - Jessica N Sanders
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Claudia Geist
- Department of Sociology, University of Utah, Salt Lake City, UT
| | - Lori Gawron
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Kyl Myers
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - David K Turok
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
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Jennings V, Haile LT, Simmons RG, Spieler J, Shattuck D. Perfect- and typical-use effectiveness of the Dot fertility app over 13 cycles: results from a prospective contraceptive effectiveness trial. EUR J CONTRACEP REPR 2019; 24:148-153. [DOI: 10.1080/13625187.2019.1581164] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Victoria Jennings
- Institute for Reproductive Health, Georgetown University, Washington, DC, USA
| | - Liya T. Haile
- Institute for Reproductive Health, Georgetown University, Washington, DC, USA
| | - Rebecca G. Simmons
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Jeff Spieler
- Independent Consultant in Population and Reproductive Health, Bethesda, MD, USA
| | - Dominick Shattuck
- Institute for Reproductive Health, Georgetown University, Washington, DC, USA
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Jennings VH, Haile LT, Simmons RG, Fultz HM, Shattuck D. Estimating six-cycle efficacy of the Dot app for pregnancy prevention. Contraception 2019; 99:52-55. [DOI: 10.1016/j.contraception.2018.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/03/2018] [Accepted: 10/03/2018] [Indexed: 10/28/2022]
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Turok DK, Simmons RG, Cappiello B, Gawron LM, Saviers-Steiger J, Sanders JN. Use of a novel suction cervical retractor for intrauterine device insertion: a pilot feasibility trial. BMJ Sex Reprod Health 2018; 45:bmjsrh-2017-200031. [PMID: 30396906 DOI: 10.1136/bmjsrh-2017-200031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 09/25/2018] [Accepted: 10/02/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The Bioceptive suction cervical retractor (SCR) is a novel device that can replace the standard single-tooth tenaculum to place traction on the cervix. A feasibility trial was conducted on the device for intrauterine device (IUD) placement. METHODS Our three-stage feasibility process began with Stage 1, where the device was tested on in-vitro and ex-vivo samples. In Stage 2, 10 women received their IUD using the device. In Stage 3, a feasibility trial, we randomly assigned 25 consenting women to receive their IUD using either the Bioceptive SCR or the standard single-tooth tenaculum. In Stages 2 and 3, we collected pain scores using an electronically adapted 100-point visual analogue scale (VAS) at eight timepoints during and after the insertion procedure, as well as satisfaction and acceptability measures. The primary outcome was the pain score after attaching the SCR or tenaculum (VAS 3). Wilcoxon rank sum tests compared pain scores between devices. RESULTS In Stage 2, pain scores with the SCR were lower than historical controls with the single-tooth tenaculum. In Stage 3, the median VAS 3 pain scores were 31 and 57 for the intervention and control groups, respectively. The differences in pain scores were not statistically significant but the trend was to lower pain scores with the intervention. Reported patient satisfaction with the SCR device was 80% in Stage 2% and 90% in Stage 3. CONCLUSIONS The Bioceptive SCR has potential as an atraumatic alternative to standard cervical retractor devices for gynaecological procedures. These findings can guide point estimates for future clinical studies. TRIAL REGISTRATION NCT02283463.
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Affiliation(s)
- David K Turok
- Department of Obstetrics and Gynecology, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Rebecca G Simmons
- Department of Obstetrics and Gynecology, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Benjamin Cappiello
- Bioceptive, Inc, New Orleans BioInnovation Center, New Orleans, Louisiana, USA
| | - Lori M Gawron
- Department of Obstetrics and Gynecology, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Jane Saviers-Steiger
- Department of Obstetrics and Gynecology, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Jessica N Sanders
- Department of Obstetrics and Gynecology, University of Utah Hospital, Salt Lake City, Utah, USA
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Geist C, Aiken AR, Sanders JN, Everett BG, Myers K, Cason P, Simmons RG, Turok DK. Beyond intent: exploring the association of contraceptive choice with questions about Pregnancy Attitudes, Timing and How important is pregnancy prevention (PATH) questions. Contraception 2018; 99:22-26. [PMID: 30125559 DOI: 10.1016/j.contraception.2018.08.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore women's responses to PATH questions (Pregnancy Attitudes, Timing and How important is pregnancy prevention) about hypothetical pregnancies and associations with contraceptive method selection among individuals who present as new contraceptive clients and desire to prevent pregnancy for at least 1 year. STUDY DESIGN The HER Salt Lake Contraceptive Initiative provided no-cost contraception to new contraceptive clients for 1 year at family planning health centers in Salt Lake County. Those who wanted to avoid pregnancy for at least 1 year and completed the enrollment survey are included in the current study. We used Poisson regression to explore the association between survey-adapted PATH questions and contraceptive method selection. RESULTS Based on an analytic sample of 3121 individuals, we found pregnancy timing and happiness about hypothetical pregnancies to be associated with method selection. Clients who report plans to wait more than 5 years [prevalence rate (PR) 1.14; 95% confidence interval (CI) 1.05-1.24], those who never wanted to become pregnant (PR 1.16; 95% CI 1.07-1.26) or those who were uncertain (PR=1.19; 95% CI 1.09-1.30) were all more likely to select IUDs and implants than women who reported wanting to become pregnant within 5 years. Greater happiness was associated with lower chance of choosing an IUD or implant (PR 0.98; 95% CI 0.96-0.999). Expressed importance of pregnancy prevention was not significantly associated with any specific contraceptive choice. CONCLUSIONS Pregnancy intentions and happiness about a hypothetical pregnancy were independently associated with selection of IUDs and implants. IMPLICATIONS Pregnancy attitudes, plans and emotions inform clients' contraceptive needs and behaviors. Client-centered contraceptive care may benefit from a more nuanced PATH approach rather than relying on a single time-oriented question about pregnancy intention.
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Roth LP, Sanders JN, Simmons RG, Bullock H, Jacobson E, Turok DK. Changes in uptake and cost of long-acting reversible contraceptive devices following the introduction of a new low-cost levonorgestrel IUD in Utah's Title X clinics: a retrospective review. Contraception 2018; 98:63-68. [PMID: 29574095 PMCID: PMC6207500 DOI: 10.1016/j.contraception.2018.03.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/30/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The objective was to assess changes in long-acting reversible contraceptive (LARC) method uptake at Utah's Title X clinics before and after introduction of a new, low-cost levonorgestrel (LNG) 52mg IUD (Liletta®). STUDY DESIGN We conducted a retrospective medical record review of LARC visits occurring at seven Title-X family planning clinics in Utah before the introduction of the low-cost LNG IUD (preintroduction period: 01/01/2014-04/30/2015) and after (postintroduction period: 05/01/2015-03/31/2016). We ran segmented, interrupted time series ordinary least squares regression models using Newey-West standard errors to assess both the change in numbers of women initiating any LARC method and the average payment amount per LARC method. We evaluated both the low-cost LNG IUD and all LARC methods. RESULTS At the outset of preintroduction period, there were 29.2 [95% confidence interval (CI): 20.1-38.4] monthly LNG IUD insertions. Immediately postintroduction, there was a significant level of increase of 14.4 LNG IUD insertions the first month (95% CI: 2.0-26.8) followed by a significant trend increase each month of 2.4 additional LNG IUD insertions (95% CI: 0.32-4.47). Postintroduction, there was a significant level of remitted-payment decrease from all sources of -$240.43 per LNG IUD (95% CI: -311.02 to 168.87) followed by a significant monthly trend decrease of -$23.01 per LNG IUD (95% CI: -32.02 to -13.98). There were minimal changes in uptake and payment of other LARC methods following the introduction of the low-cost LNG IUD. CONCLUSIONS Following introduction of a low-cost LNG IUD at Title X clinics, LNG IUD initiation increased and average payment for the method decreased. IMPLICATIONS Reducing the cost of LARC methods, both to clinics and to patients, is essential to expanding access. Additional efforts to develop and provide access to low-cost copper IUDs and subdermal implants as well as novel LARC methods should be continued.
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Affiliation(s)
- Lauryn P Roth
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
| | - Jessica N Sanders
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
| | - Rebecca G Simmons
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
| | - Holly Bullock
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
| | - Elizabeth Jacobson
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
| | - David K Turok
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209.
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Shattuck D, Haile LT, Simmons RG. Lessons From the Dot Contraceptive Efficacy Study: Analysis of the Use of Agile Development to Improve Recruitment and Enrollment for mHealth Research. JMIR Mhealth Uhealth 2018; 6:e99. [PMID: 29678802 PMCID: PMC5935800 DOI: 10.2196/mhealth.9661] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/16/2018] [Accepted: 03/07/2018] [Indexed: 11/13/2022] Open
Abstract
Background Smartphone apps that provide women with information about their daily fertility status during their menstrual cycles can contribute to the contraceptive method mix. However, if these apps claim to help a user prevent pregnancy, they must undergo similar rigorous research required for other contraceptive methods. Georgetown University’s Institute for Reproductive Health is conducting a prospective longitudinal efficacy trial on Dot (Dynamic Optimal Timing), an algorithm-based fertility app designed to help women prevent pregnancy. Objective The aim of this paper was to highlight decision points during the recruitment-enrollment process and the effect of modifications on enrollment numbers and demographics. Recruiting eligible research participants for a contraceptive efficacy study and enrolling an adequate number to statistically assess the effectiveness of Dot is critical. Recruiting and enrolling participants for the Dot study involved making decisions based on research and analytic data, constant process modification, and close monitoring and evaluation of the effect of these modifications. Methods Originally, the only option for women to enroll in the study was to do so over the phone with a study representative. On noticing low enrollment numbers, we examined the 7 steps from the time a woman received the recruitment message until she completed enrollment and made modifications accordingly. In modification 1, we added call-back and voicemail procedures to increase the number of completed calls. Modification 2 involved using a chat and instant message (IM) features to facilitate study enrollment. In modification 3, the process was fully automated to allow participants to enroll in the study without the aid of study representatives. Results After these modifications were implemented, 719 women were enrolled in the study over a 6-month period. The majority of participants (494/719, 68.7%) were enrolled during modification 3, in which they had the option to enroll via phone, chat, or the fully automated process. Overall, 29.2% (210/719) of the participants were enrolled via a phone call, 19.9% (143/719) via chat/IM, and 50.9% (366/719) directly through the fully automated process. With respect to the demographic profile of our study sample, we found a significant statistical difference in education level across all modifications (P<.05) but not in age or race or ethnicity (P>.05). Conclusions Our findings show that agile and consistent modifications to the recruitment and enrollment process were necessary to yield an appropriate sample size. An automated process resulted in significantly higher enrollment rates than one that required phone interaction with study representatives. Although there were some differences in demographic characteristics of enrollees as the process was modified, in general, our study population is diverse and reflects the overall United States population in terms of race/ethnicity, age, and education. Additional research is proposed to identify how differences in mode of enrollment and demographic characteristics may affect participants’ performance in the study. Trial Registration ClinicalTrials.gov NCT02833922; http://clinicaltrials.gov/ct2/show/NCT02833922 (Archived by WebCite at http://www.webcitation.org/6yj5FHrBh)
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Affiliation(s)
- Dominick Shattuck
- Institute for Reproductive Health at Georgetown University, Washington, DC, United States
| | - Liya T Haile
- Institute for Reproductive Health at Georgetown University, Washington, DC, United States
| | - Rebecca G Simmons
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, United States
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Sanders JN, Myers K, Gawron LM, Simmons RG, Turok DK. Contraceptive Method Use During the Community-Wide HER Salt Lake Contraceptive Initiative. Am J Public Health 2018; 108:550-556. [PMID: 29470119 PMCID: PMC5844407 DOI: 10.2105/ajph.2017.304299] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To describe a community-wide contraception initiative and assess changes in method use when cost and access barriers are removed in an environment with client-centered counseling. METHODS HER Salt Lake is a prospective cohort study occurring during three 6-month periods (September 2015 through March 2017) and nested in a quasiexperimental observational study. The sample was women aged 16 to 45 years receiving new contraceptive services at health centers in Salt Lake County, Utah. Following the control period, intervention 1 removed cost and ensured staffing and pharmacy stocking; intervention 2 introduced targeted electronic outreach. We used logistic regression and interrupted time series regression analyses to assess impact. RESULTS New contraceptive services were provided to 4107 clients in the control period, 3995 in intervention 1, and 3407 in intervention 2. The odds of getting an intrauterine device or implant increased 1.6 times (95% confidence interval [CI] = 1.5, 1.6) during intervention 1 and 2.5 times (95% CI = 2.2, 2.8) during intervention 2, relative to the control period. Time series analysis demonstrated that participating health centers placed an additional 59 intrauterine devices and implants on average per month (95% CI = 13, 105) after intervention 1. CONCLUSIONS Removing client cost and increasing clinic capacity was associated with shifts in contraceptive method mix in an environment with client-centered counseling; targeted electronic outreach further augmented these results.
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Affiliation(s)
- Jessica N Sanders
- All of the authors are with the Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City
| | - Kyl Myers
- All of the authors are with the Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City
| | - Lori M Gawron
- All of the authors are with the Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City
| | - Rebecca G Simmons
- All of the authors are with the Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City
| | - David K Turok
- All of the authors are with the Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City
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Simmons RG, Shattuck DC, Jennings VH. Conflict of Interest Addendum: Assessing the Efficacy of an App-Based Method of Family Planning: The Dot Study Protocol. JMIR Res Protoc 2018; 7:e9. [PMID: 29547386 PMCID: PMC5980484 DOI: 10.2196/resprot.8829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 11/22/2022] Open
Affiliation(s)
- Rebecca G Simmons
- Institute for Reproductive Health, Georgetown University, Washington, DC, United States
| | - Dominick C Shattuck
- Institute for Reproductive Health, Georgetown University, Washington, DC, United States
| | - Victoria H Jennings
- Institute for Reproductive Health, Georgetown University, Washington, DC, United States
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Haile LT, Fultz HM, Simmons RG, Shelus V. Market-testing a smartphone application for family planning: assessing potential of the CycleBeads app in seven countries through digital monitoring. Mhealth 2018; 4:27. [PMID: 30148140 PMCID: PMC6088200 DOI: 10.21037/mhealth.2018.06.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/08/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The advent of new technological approaches to family planning has the potential to address unmet need in low- and middle-income countries. Provision of fertility awareness-based apps have the ability to provide accessible, direct-to-user fertility information to help women achieve their reproductive goals. The CycleBeads app, a digital platform for the Standard Days Method (SDM), a modern method of family planning, helps women achieve or prevent pregnancy, or track their cycles using the only their period start dates. METHODS Brief social marketing campaigns were launched by the app developer to monitor cost and distribution of the CycleBeads app, understand the user profile, and assess user experience. Monitoring and evaluation through in-app micro surveys occurred over a 6-cycle period in seven countries: Egypt, Ghana, India, Jordan, Kenya, Nigeria, and Rwanda. In-app micro-surveys were utilized to collect data around demographics, mode of use of the app, prior experiences with family planning, and satisfaction to better understand women's interactions with the apps, and the possibility for meeting unmet need. Analyzes focused on women who were using the app to prevent pregnancy or track their cycles. RESULTS Social media campaigns proved to be an easy, low-cost approach to advertising the CycleBeads app. As a result, 356,520 women downloaded the app, and the cost to the advertiser per download ranged from $0.17-0.69. A majority of app users were between 20-29 years old, married or in exclusive relationships. Overall, 39.9% of users were using the app to prevent pregnancy, 38.5% to plan a pregnancy, and 21.6% were tracking their cycles. Among the users preventing pregnancy, 64.1% of women had not used a family planning method 3 months before downloading the CycleBeads app. One-third of users who were using the app to track their cycles, reported that they had not been using any form of family planning. In all seven countries, nearly 60% of women reported that they would definitely recommend the CycleBeads app to a friend, indicating their satisfaction with the app. CONCLUSIONS Our main findings indicate that a social media campaign is a low-cost approach to making the CycleBeads app accessible to women. The app addresses multiple reproductive intentions and attracts a diverse demographic of users across different life stages. For many women the app was the first modern method they used in the last 3 months, showing that fertility awareness-based apps have the potential to address an unmet need. Future studies should focus on changes in behavior during the fertile window, partner communication, and future family planning intentions.
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Affiliation(s)
- Liya T Haile
- Institute for Reproductive Health, Georgetown University, Washington, DC, USA
| | - Hanley M Fultz
- Institute for Reproductive Health, Georgetown University, Washington, DC, USA
| | - Rebecca G Simmons
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Victoria Shelus
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Starling MS, Kandel Z, Haile L, Simmons RG. User profile and preferences in fertility apps for preventing pregnancy: an exploratory pilot study. Mhealth 2018; 4:21. [PMID: 30050917 PMCID: PMC6043758 DOI: 10.21037/mhealth.2018.06.02] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/30/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The rapid proliferation of fertility apps has created a market that has the potential to address the needs of women and couples worldwide. Some women who seek to prevent pregnancy are making behavioral decisions based on information they receive from fertility apps, yet fertility apps may not always be accurate and reliance on them could lead to unintended pregnancies. Little research has been done to understand who uses fertility apps for pregnancy prevention, how those who use them perceive their efficacy, and their preferences for how apps should be designed and presented to accurately assist them in preventing pregnancy. METHODS A web-based pilot survey was launched through Facebook recruiting women who either currently use a fertility app for pregnancy prevention or intend to use one in the future. Data collected from 1,000 women surveyed user preferences around fertility app characteristics, including aesthetics, features, functionality, and reputation. User knowledge about fertility and reproduction was assessed, and knowledge categories were created. Chi-square tests assessed differences in app characteristic preferences according to knowledge category. Additional qualitative analyses on free-text answers explored which features of apps are important to users when they search for one to use. RESULTS Approximately one quarter (23.1%) of survey respondents reported currently using a fertility app or had used one in the recent past, and 76.9% reported intention to use one in the future. A majority of both current and intended users (65.4%) had some knowledge of fertility and reproduction, while 16.5% had very little knowledge. 18.1% reported receiving prior provider counseling on using a fertility-awareness based method. Users across all knowledge groups said it was very important for apps to be science-based and that they identify fertile days during the menstrual cycle. CONCLUSIONS Women who use or wish to use apps to prevent pregnancy are seeking apps that are scientifically sound and provide them personalized information around their potential fertility. However, most fertility apps women reported using lack the capability for true fertility-awareness based method application for accurate, reliable pregnancy prevention. More research is needed to evaluate apps for efficacy and accuracy preventing pregnancy. Collaborations between app developers and women's health experts are encouraged, as well as informed consumerism campaigns.
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Affiliation(s)
| | - Zosha Kandel
- Starling Consulting Group, Inc., Durham, NC, USA
| | - Liya Haile
- Institute for Reproductive Health, Georgetown University, Washington, DC, USA
| | - Rebecca G. Simmons
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, USA
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Simmons RG, Shattuck DC, Jennings VH. Assessing the Efficacy of an App-Based Method of Family Planning: The Dot Study Protocol. JMIR Res Protoc 2017; 6:e5. [PMID: 28100441 PMCID: PMC5288563 DOI: 10.2196/resprot.6886] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/16/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Some 222 million women worldwide have unmet needs for contraception; they want to avoid pregnancy, but are not using a contraceptive method, primarily because of concerns about side effects associated with most available methods. Expanding contraceptive options-particularly fertility awareness options that provide women with information about which days during their menstrual cycles they are likely to become pregnant if they have unprotected intercourse-has the potential to reduce unmet need. Making these methods available to women through their mobile phones can facilitate access. Indeed, many fertility awareness applications have been developed for smartphones, some of which are digital platforms for existing methods, requiring women to enter information about fertility signs such as basal body temperature and cervical secretions. Others are algorithms based on (unexplained) calculations of the fertile period of the menstrual cycle. Considering particularly this latter (largely untested) group, it is critical that these apps be subject to the same rigorous research as other contraceptive methods. Dynamic Optimal Timing, available via the Dot app as a free download for iPhone and Android devices, is one such method and the only one that has published the algorithm that forms its basis. It combines historical cycle data with a woman's own personal cycle history, continuing to accrue this information over time to identify her fertile period. While Dot has a theoretical failure rate of only 3 in 100 for preventing pregnancy with perfect use, its effectiveness in typical use has yet to be determined. OBJECTIVE The study objective is to assess both perfect and typical use to determine the efficacy of the Dot app for pregnancy prevention. METHODS To determine actual use efficacy, the Institute for Reproductive Health is partnering with Cycle Technologies, which developed the Dot app, to conduct a prospective efficacy trial, following 1200 women over the course of 13 menstrual cycles to assess pregnancy status over time. This paper outlines the protocol for this efficacy trial, following the Standard Protocol Items: Recommendations for Intervention Trials checklist, to provide an overview of the rationale, methodology, and analysis plan. Participants will be asked to provide daily sexual history data and periodically answer surveys administered through a call center or directly on their phone. RESULTS Funding for the study was provided in 2013 under the United States Agency for International Development Fertility Awareness for Community Transformation project. Recruitment for the study will begin in January of 2017. The study is expected to last approximately 18 months, depending on recruitment. Findings on the study's primary outcomes are expected to be finalized by September 2018. CONCLUSIONS Reproducibility and transparency, important aspects of all research, are particularly critical in developing new approaches to research design. This protocol outlines the first study to prospectively test both the efficacy (correct use) and effectiveness (actual use) of a pregnancy prevention app. This protocol and the processes it describes reflect the dynamic integration of mobile technologies, a call center, and Health Insurance Portability and Accountability Act-compliant study procedures. Future fertility app studies can build on our approaches to develop methodologies that can contribute to the evidence base around app-based methods of contraception. CLINICALTRIAL ClinicalTrials.gov NCT02833922; https://clinicaltrials.gov/ct2/show/NCT02833922 (Archived be WebCite at http://www.webcitation.org/6nDkr0e76).
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Affiliation(s)
- Rebecca G Simmons
- Institute for Reproductive Health, Georgetown University, Washington, DC, United States
| | - Dominick C Shattuck
- Institute for Reproductive Health, Georgetown University, Washington, DC, United States
| | - Victoria H Jennings
- Institute for Reproductive Health, Georgetown University, Washington, DC, United States
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Steffen LE, Boucher KM, Damron BH, Pappas LM, Walters ST, Flores KG, Boonyasiriwat W, Vernon SW, Stroup AM, Schwartz MD, Edwards SL, Kohlmann WK, Lowery JT, Wiggins CL, Hill DA, Higginbotham JC, Burt R, Simmons RG, Kinney AY. Efficacy of a Telehealth Intervention on Colonoscopy Uptake When Cost Is a Barrier: The Family CARE Cluster Randomized Controlled Trial. Cancer Epidemiol Biomarkers Prev 2015; 24:1311-8. [PMID: 26101306 DOI: 10.1158/1055-9965.epi-15-0150] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/02/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We tested the efficacy of a remote tailored intervention Tele-Cancer Risk Assessment and Evaluation (TeleCARE) compared with a mailed educational brochure for improving colonoscopy uptake among at-risk relatives of colorectal cancer patients and examined subgroup differences based on participant reported cost barriers. METHODS Family members of colorectal cancer patients who were not up-to-date with colonoscopy were randomly assigned as family units to TeleCARE (N = 232) or an educational brochure (N = 249). At the 9-month follow-up, a cost resource letter listing resources for free or reduced-cost colonoscopy was mailed to participants who had reported cost barriers and remained nonadherent. Rates of medically verified colonoscopy at the 15-month follow-up were compared on the basis of group assignment and within group stratification by cost barriers. RESULTS In intent-to-treat analysis, 42.7% of participants in TeleCARE and 24.1% of participants in the educational brochure group had a medically verified colonoscopy [OR, 2.37; 95% confidence interval (CI) 1.59-3.52]. Cost was identified as a barrier in both groups (TeleCARE = 62.5%; educational brochure = 57.0%). When cost was not a barrier, the TeleCARE group was almost four times as likely as the comparison to have a colonoscopy (OR, 3.66; 95% CI, 1.85-7.24). The intervention was efficacious among those who reported cost barriers; the TeleCARE group was nearly twice as likely to have a colonoscopy (OR, 1.99; 95% CI, 1.12-3.52). CONCLUSIONS TeleCARE increased colonoscopy regardless of cost barriers. IMPACT Remote interventions may bolster screening colonoscopy regardless of cost barriers and be more efficacious when cost barriers are absent.
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Affiliation(s)
- Laurie E Steffen
- University of New Mexico Cancer Center, Albuquerque, New Mexico. Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Kenneth M Boucher
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah. Department of Oncologic Sciences, University of Utah, Salt Lake City, Utah
| | | | - Lisa M Pappas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Scott T Walters
- Department of School of Public Health Behavioral and Community Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Kristina G Flores
- University of New Mexico Cancer Center, Albuquerque, New Mexico. Division of Epidemiology, Biostatistics, and Prevention, Department of Internal Medicine, School of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | | | - Sally W Vernon
- Division of Health Promotion and Behavioral Sciences, The University of Texas School of Public Health, Houston, Texas
| | - Antoinette M Stroup
- Department of Epidemiology, Rutgers School of Public Health, Piscataway Township, New Jersey. Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Marc D Schwartz
- Department of Oncology, Georgetown University, Washington, DC. Lombardi Comprehensive Cancer Center, Washington, DC
| | - Sandra L Edwards
- Division of Epidemiology, Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Wendy K Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jan T Lowery
- Department of Epidemiology, University of Colorado School of Public Health, Aurora, Colorado
| | - Charles L Wiggins
- University of New Mexico Cancer Center, Albuquerque, New Mexico. Division of Epidemiology, Biostatistics, and Prevention, Department of Internal Medicine, School of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Deirdre A Hill
- University of New Mexico Cancer Center, Albuquerque, New Mexico. Division of Epidemiology, Biostatistics, and Prevention, Department of Internal Medicine, School of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - John C Higginbotham
- Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, Alabama
| | - Randall Burt
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Anita Y Kinney
- University of New Mexico Cancer Center, Albuquerque, New Mexico. Division of Epidemiology, Biostatistics, and Prevention, Department of Internal Medicine, School of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.
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Kinney AY, Boonyasiriwat W, Walters ST, Pappas LM, Stroup AM, Schwartz MD, Edwards SL, Rogers A, Kohlmann WK, Boucher KM, Vernon SW, Simmons RG, Lowery JT, Flores K, Wiggins CL, Hill DA, Burt RW, Williams MS, Higginbotham JC. Telehealth personalized cancer risk communication to motivate colonoscopy in relatives of patients with colorectal cancer: the family CARE Randomized controlled trial. J Clin Oncol 2014; 32:654-62. [PMID: 24449229 PMCID: PMC3927734 DOI: 10.1200/jco.2013.51.6765] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The rate of adherence to regular colonoscopy screening in individuals at increased familial risk of colorectal cancer (CRC) is suboptimal, especially among rural and other geographically underserved populations. Remote interventions may overcome geographic and system-level barriers. We compared the efficacy of a telehealth-based personalized risk assessment and communication intervention with a mailed educational brochure for improving colonoscopy screening among at-risk relatives of patients with CRC. METHODS Eligible individuals age 30 to 74 years who were not up-to-date with risk-appropriate screening and were not candidates for genetic testing were recruited after contacting patients with CRC or their next of kin in five states. Enrollees were randomly assigned as family units to either an active, personalized intervention that incorporated evidence-based risk communication and behavior change techniques, or a mailed educational brochure. The primary outcome was medically verified colonoscopy within 9 months of the intervention. RESULTS Of the 481 eligible and randomly assigned at-risk relatives, 79.8% completed the outcome assessments within 9 months; 35.4% of those in the personalized intervention group and 15.7% of those in the comparison group obtained a colonoscopy. In an intent-to-treat analysis, the telehealth group was almost three times as likely to get screened as the low-intensity comparison group (odds ratio, 2.83; 95% CI, 1.87 to 4.28; P < .001). Persons residing in rural areas and those with lower incomes benefitted at the same level as did urban residents. CONCLUSION Remote personalized interventions that consider family history and incorporate evidence-based risk communication and behavior change strategies may promote risk-appropriate screening in close relatives of patients with CRC.
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Affiliation(s)
- Anita Y. Kinney
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Watcharaporn Boonyasiriwat
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Scott T. Walters
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Lisa M. Pappas
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Antoinette M. Stroup
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Marc D. Schwartz
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Sandra L. Edwards
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Amy Rogers
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Wendy K. Kohlmann
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Kenneth M. Boucher
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Sally W. Vernon
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Rebecca G. Simmons
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Jan T. Lowery
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Kristina Flores
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Charles L. Wiggins
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Deirdre A. Hill
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Randall W. Burt
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Marc S. Williams
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
| | - John C. Higginbotham
- Anita Y. Kinney, Antoinette M. Stroup, Sandra L. Edwards, Kenneth M. Boucher, and Randall W. Burt, School of Medicine, University of Utah; Anita Y. Kinney, Lisa M. Pappas, Antoinette M. Stroup, Sandra L. Edwards, Amy Rogers, Wendy K. Kohlmann, Kenneth M. Boucher, Rebecca G. Simmons, and Randall W. Burt, Huntsman Cancer Institute, University of Utah; Marc S. Williams, Intermountain Healthcare, Salt Lake City, UT; Watcharaporn Boonyasiriwat, Chulalongkom University, Bangkok, Thailand; Scott T. Walters, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth; Sally W. Vernon, The University of Texas School of Public Health, Houston, TX; Marc D. Schwartz, Georgetown University; Marc D. Schwartz, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Jan T. Lowery, Colorado School of Public Health, University of Colorado, Denver, CO; Kristina Flores, University of New Mexico Cancer Center; Anita Y. Kinney, Charles L. Wiggins, and Deirdre A. Hill, University of New Mexico Cancer Center and School of Medicine, Albuquerque, NM; Marc S. Williams, Genomic Medicine Institute, Geisinger Health System, Danville, PA; John C. Higginbotham, Community and Rural Medicine Institute for Rural Health Research, College of Community Health Sciences, University of Alabama, Tuscaloosa, AL
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Dew MA, Roth LH, Switzer GE, Schulberg HC, Simmons RG, Kormos RL, Griffith BP. Gender differences in patterns of emotional distress following heart transplantation. J Clin Psychol Med Settings 2013; 3:367-86. [PMID: 24226846 DOI: 10.1007/bf01994020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The study provides the first empirical evaluation of gender differences in psychological symptomatology and DSM-III-R major depressive disorder (MDD) across the first year following heart transplantation. An important goal was to identify physical health-related and psychosocial factors that could account for, or mediate, any association between gender and psychological distress. The sample for the present analyses was drawn from a larger cohort of 172 heart recipients and included all 28 women in the cohort plus 118 men who were matched demographically with the group of women. Detailed patient assessments were completed at 2, 7, and 12 months posttransplant. As expected, women's symptom levels were consistently higher than men's. However, while men's symptom levels in all areas declined with time posttransplant, women's distress in the area of depression initially improved but then worsened by the 12-month assessment. The distribution of episodes of MDD showed a temporal pattern of gender differences similar to that of depressive symptoms. The most important mediators of the gender-depression relationship were factors related to early posttransplant daily functional limitations: women reported more impairments in daily activities. Higher levels of such impairments, in turn, predicted subsequently higher depression levels by 12 months posttransplant. Several additional variables pertaining to transplant-related concerns and a low sense of personal mastery-while not serving as mediators-exerted their own independent effects on 12-month depression levels. The findings are relevant to the tailoring of educational and clinical interventions to the individual needs of women and men who receive heart transplants.
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Affiliation(s)
- M A Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania
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Simmons RG, Lee YCA, Stroup AM, Edwards SL, Rogers A, Johnson C, Wiggins CL, Hill DA, Cress RD, Lowery J, Walters ST, Jasperson K, Higginbotham JC, Williams MS, Burt RW, Schwartz MD, Kinney AY. Examining the challenges of family recruitment to behavioral intervention trials: factors associated with participation and enrollment in a multi-state colonoscopy intervention trial. Trials 2013; 14:116. [PMID: 23782890 PMCID: PMC3691526 DOI: 10.1186/1745-6215-14-116] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 04/02/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Colonoscopy is one of the most effective methods of cancer prevention and detection, particularly for individuals with familial risk. Recruitment of family members to behavioral intervention trials remains uniquely challenging, owing to the intensive process required to identify and contact them. Recruiting at-risk family members involves contacting the original cancer cases and asking them to provide information about their at-risk relatives, who must then be contacted for study enrollment. Though this recruitment strategy is common in family trials, few studies have compared influences of patient and relative participation to nonparticipation. Furthermore, although use of cancer registries to identify initial cases has increased, to our knowledge no study has examined the relationship between registries and family recruitment outcomes. METHODS This study assessed predictors of case participation and relative enrollment in a recruitment process that utilized state cancer registries. Participation characteristics were analyzed with separate multivariable logistic regressions in three stages: (1) cancer registry-contacted colorectal cancer (CRC) cases who agreed to study contact; (2) study-contacted CRC cases who provided at-risk relative information; and (3) at-risk relatives contacted for intervention participation. RESULTS Cancer registry source was predictive of participation for both CRC cases and relatives, though relative associations (odds ratios) varied across registries. Cases were less likely to participate if they were Hispanic or nonwhite, and were more likely to participate if they were female or younger than 50 at cancer diagnosis. At-risk relatives were more likely to participate if they were from Utah, if another family member was also participating in the study, or if they had previously had a colonoscopy. The number of eligible cases who had to be contacted to enroll one eligible relative varied widely by registry, from 7 to 81. CONCLUSIONS Family recruitment utilizing cancer registry-identified cancer cases is feasible, but highly dependent on both the strategies and protocols of those who are recruiting and on participant characteristics such as sex, race, or geography. Devising comprehensive recruitment protocols that specifically target those less likely to enroll may help future research meet recruitment goals. TRIAL REGISTRATION Family Colorectal Cancer Awareness and Risk Education Project NCT01274143.
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Affiliation(s)
- Rebecca G Simmons
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Yuan-Chin Amy Lee
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA
| | - Antoinette M Stroup
- Utah Cancer Registry, 650 Komas Drive, Suite 106B, Salt Lake City, UT, 84108, USA
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Sandra L Edwards
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Amy Rogers
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Christopher Johnson
- Cancer Data Registry of Idaho, 615 N. 7th Street, PO Box 1278, Boise, ID, 83701, USA
| | - Charles L Wiggins
- New Mexico Tumor Registry, University of New Mexico Cancer Center, MSC 11 6020, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Deirdre A Hill
- Department of Internal Medicine, Division of Epidemiology and Biostatistics and University of New Mexico Cancer Research and Treatment Center, University of New Mexico School of Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Rosemary D Cress
- California Cancer Registry, 1825 Bell Street, Suite 102, Sacramento, CA, 95825, USA
| | - Jan Lowery
- University of Colorado Cancer Center, 13001 E. 17th St., MS F-538, Aurora, CO, 80045, USA
| | - Scott T Walters
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd, EAD 709, Fort Worth, TX, 76107, USA
| | - Kory Jasperson
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - John C Higginbotham
- Institute for Rural Health, University of Alabama, Tuscaloosa Campus, 850 5th Avenue East, Tuscaloosa, AL, 35401, USA
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger Research, Weis Center for Research, 100 N Academy Ave. Mail Stop 26-20, Danville, PA, 17822, USA
| | - Randall W Burt
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Marc D Schwartz
- Georgetown University, Harris Building, 3300 Whitehaven St., N.W., Washington DC, 20007, USA
- Lombardi Comprehensive Cancer Center, 3970 Reservoir Rd NW E501, Washington, DC, 20007, USA
| | - Anita Y Kinney
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
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Pengchit W, Walters ST, Simmons RG, Kohlmann W, Burt RW, Schwartz MD, Kinney AY. Motivation-based intervention to promote colonoscopy screening: an integration of a fear management model and motivational interviewing. J Health Psychol 2011; 16:1187-97. [PMID: 21464114 DOI: 10.1177/1359105311402408] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Colorectal cancer (CRC) screening rates have been low despite effectiveness of screening in reducing CRC mortality. This article outlines the theoretical background and development of an innovative, telephone-based risk communication designed to promote screening among individuals at increased risk for familial CRC. This ongoing intervention integrates the Extended Parallel Process Model of fear management and the motivational interviewing counselling style. Tailoring and implementation intentions are incorporated. The primary outcome is self-reported colonoscopy within nine months following intervention. If proven effective, the remote intervention could be broadly disseminated to individuals at increased familial CRC risk, especially those in geographically underserved areas.
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Abstract
During its 10-year existence, the National Marrow Donor Program (NMDP) has been extremely successful at recruiting potential bone marrow donors to join the volunteer registry. Due in part to successful recruitment and the longevity of the registry, the focus of the NMDP has now shifted to decreasing potential attrition when volunteers are recontacted for additional testing to determine whether they would be the optimal donor for a specific patient. Our own interest in the bone marrow donation process led us to examine four domains of variables - demographic characteristics, volunteer history, recruitment-related characteristics and donation-related concerns - that we hypothesized would be associated with increased likelihood of donor attrition at a key donor decision-point (DR-stage blood typing). Questionnaires were mailed to potential donors after they were contacted at the DR-stage, and had made the decision of whether or not to continue with blood typing. Our final sample included 756 volunteers who decided to continue with typing, and 258 individuals who declined further participation in the registry. In the bivariate analyses, factors in three of the four domains (all except demographic characteristics) were found to be substantially correlated with likelihood of attrition. Logistic regression indicated that nine central variables across the three domains produced the majority of increased attrition likelihood. Finally, a dose-response analysis suggested that as the number of attrition-related factors endorsed by an individual increased, his/her likelihood of dropping out of the registry also increased. Implications for future research and interventions to reduce potential donor attrition are discussed.
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Affiliation(s)
- G E Switzer
- Department of Medicine, University of Pittsburgh, PA 15213, USA
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Dew MA, Goycoolea JM, Stukas AA, Switzer GE, Simmons RG, Roth LH, DiMartini A. Temporal profiles of physical health in family members of heart transplant recipients: predictors of health change during caregiving. Health Psychol 1998. [PMID: 9548705 DOI: 10.1037//0278-6133.17.2.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined patterns of change in the physical health and well-being of 133 family caregivers to heart transplant recipients during the 1st year after transplant. Caregivers were assessed at 2, 7, and 12 months after transplant. Cluster analysis was used to identify temporal profiles reflecting unique patterns of change in the direction and nature of caregivers' physical health; their temporal profiles showed either (a) a worsening of general medical condition, with weight gain (14% of the sample); (b) worsening medical condition with weight loss (15%); (c) weight gain with stable medical condition (41%); (d) weight loss with slightly improving medical condition (21%); or (e) worsening health perceptions with relatively little objective evidence of change in medical condition or weight (8%). Subsequent multivariate analyses indicated that caregiver characteristics measured at baseline and reflecting caregiving burden, coping styles, demographics, and health history reliably predicted membership in the pattern-of-health-change groups. Among the findings, caregivers who showed a pattern of medical decline with weight loss had a poorer health history and weaker coping styles (lower mastery and higher use of avoidance coping) than other caregivers. Caregivers who experienced medical decline with weight gain had the greatest levels of caregiver burden. These findings are relevant to the design of interventions to maximize not only caregivers' health, but the health of the family members for whom they provide care.
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Affiliation(s)
- M A Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA.
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Dew MA, Goycoolea JM, Stukas AA, Switzer GE, Simmons RG, Roth LH, DiMartini A. Temporal profiles of physical health in family members of heart transplant recipients: predictors of health change during caregiving. Health Psychol 1998; 17:138-51. [PMID: 9548705 DOI: 10.1037/0278-6133.17.2.138] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined patterns of change in the physical health and well-being of 133 family caregivers to heart transplant recipients during the 1st year after transplant. Caregivers were assessed at 2, 7, and 12 months after transplant. Cluster analysis was used to identify temporal profiles reflecting unique patterns of change in the direction and nature of caregivers' physical health; their temporal profiles showed either (a) a worsening of general medical condition, with weight gain (14% of the sample); (b) worsening medical condition with weight loss (15%); (c) weight gain with stable medical condition (41%); (d) weight loss with slightly improving medical condition (21%); or (e) worsening health perceptions with relatively little objective evidence of change in medical condition or weight (8%). Subsequent multivariate analyses indicated that caregiver characteristics measured at baseline and reflecting caregiving burden, coping styles, demographics, and health history reliably predicted membership in the pattern-of-health-change groups. Among the findings, caregivers who showed a pattern of medical decline with weight loss had a poorer health history and weaker coping styles (lower mastery and higher use of avoidance coping) than other caregivers. Caregivers who experienced medical decline with weight gain had the greatest levels of caregiver burden. These findings are relevant to the design of interventions to maximize not only caregivers' health, but the health of the family members for whom they provide care.
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Affiliation(s)
- M A Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA.
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Switzer GE, Dew MA, Magistro CA, Goycoolea JM, Twillman RK, Alter C, Simmons RG. The effects of bereavement on adult sibling bone marrow donors' psychological well-being and reactions to donation. Bone Marrow Transplant 1998; 21:181-8. [PMID: 9489636 DOI: 10.1038/sj.bmt.1701063] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
As living organ, tissue, and bone marrow donation become increasingly prevalent treatments for a variety of diseases, better understanding of living donors' experiences, especially when the recipient does not survive after the transplant, also becomes more critical. Although some psychological outcome data exist concerning living donation, there have been no systematic prospective investigations, to date, of the psychological impact of bereavement among sibling bone marrow donors. Studies of bereavement effects in other donation settings such as unrelated bone marrow donation and related kidney donation, suggest that bereavement may have a significant impact on donors' reactions. The present investigation studied a panel of sibling bone marrow donors at three key points in the donation process in order to (1) examine donor psychological well-being across time, and (2) investigate the effect of the sibling recipient's death on donor well-being. We surveyed sibling donors by mail 1-2 weeks prior to donation, 1-2 weeks following donation, and again 1 year after their donation. In general, all donors reported high levels of predonation self-esteem, mastery, happiness and life satisfaction. As might be expected, bereaved donors felt less as if their donation had really helped their sibling as time passed. However, despite such donation-specific perceptions, bereaved donors experienced global psychological gains following bereavement including enhanced self-esteem, happiness, and life satisfaction compared to donors whose siblings were still living. These findings suggest that physicians and mental health practitioners should monitor donors' psychological well-being for extended periods post-donation, and should consider clinical interventions for bereaved and nonbereaved sibling donors.
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Affiliation(s)
- G E Switzer
- Department of Medicine, University of Pittsburgh, PA 15213, USA
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Abstract
Medical advances in bone marrow transplantation techniques and immunosuppressive medications have dramatically increased the number of such transplants performed each year, and consequently, the demand for bone marrow from unrelated donors. Although physiological aspects of bone marrow donation have been thoroughly investigated, very few studies have examined psychosocial factors that may impact individuals' donation decisions and outcomes. To examine one particular set of donor psychosocial issues, this study investigated motives for bone marrow donation among 343 unrelated bone marrow donors who donated through the National Marrow Donor Program. Six distinct types of donor motives were identified from open-ended questionnaire responses. Donors most frequently reported motives reflecting some awareness of both the costs (to themselves) and potential benefits (to themselves and the recipient) of donation. A desire to act in accordance with social or religious precepts, expected positive feelings about donating, empathy for the recipient, and the simple desire to help another person were also commonly cited reasons for donating. Among a series of donor background characteristics, donors' gender was the variable most strongly associated with motive type; women were most likely to cite expected positive feelings, empathy, and the desire to help someone. Central study findings indicated that donor motives predicted donors reactions to donation even after the effects of donor background characteristics (including gender) were controlled. Donors who reported exchange motives (weighing costs and benefits) and donors who reported simple (or idealized) helping motives experienced the donation as less positive in terms of higher predonation ambivalence and negative postdonation psychological reactions than did remaining donors. Donors who reported positive feeling and empathy motives had the most positive donation reactions in terms of lower ambivalence, and feeling like better persons postdonation. These finding add substantially to the body of work concerning medical volunteerism generally, and also have important practical implications for the recruitment and education of potential bone marrow donors.
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Affiliation(s)
- G E Switzer
- Department of Medicine, University of Pittsburgh, USA
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Affiliation(s)
- G E Switzer
- University of Pittsburgh Medical Center, Pennsylvania 15213, USA
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Dew MA, Roth LH, Schulberg HC, Simmons RG, Kormos RL, Trzepacz PT, Griffith BP. Prevalence and predictors of depression and anxiety-related disorders during the year after heart transplantation. Gen Hosp Psychiatry 1996; 18:48S-61S. [PMID: 8937923 DOI: 10.1016/s0163-8343(96)00077-1] [Citation(s) in RCA: 127] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study longitudinally evaluates prevalence, clinical characteristics, and risk factors for DSM-III-R Major Depression, Generalized Anxiety Disorder (GAD), associated Adjustment Disorders, and Post-Traumatic Stress Disorder related to the transplant (PTSD-T) in a large, representative sample of heart recipients followed during the first year after transplantation. Lifetime pretransplant prevalence as well as 1-year posttransplant rates were determined for the 154 recipients via standardized clinical interview schedules. Major Depression was the most prevalent disorder posttransplant (1- year rate of 17.3%), followed by PTSD-T (13.7%), and Adjustment Disorders (10.0%). There were no cases of GAD. Specific pretransplant and perioperative factors increased recipients' risk for any psychiatric disorder (vs none) posttransplant, including pretransplant psychiatric history; poor social supports from primary family caregiver, other relatives, and friends; the use of avoidance coping strategies for managing health problems; and low self-esteem early posttransplant. Within diagnostic groups, additional risk factors distinguished recipients with anxiety-related vs depressive disorders posttransplant: those at highest relative risk for anxiety had waited more briefly for a donor heart, were more likely to have a family psychiatric history, had the poorest family and friend support of all recipients, utilized the poorest coping skills, and had a poor sense of mastery. The findings have implications for the development of primary and secondary prevention strategies for psychiatric disorder in heart recipient populations.
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Affiliation(s)
- M A Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA 15213, USA
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Abstract
This article examines the responses of bone marrow donors to the death of the unrelated person to whom they donated. Data analyzed were 330 questionnaires and fifty in-depth interviews collected from donors in the National Marrow Donor Program at one year post-donation. Death of the recipient produced feelings of guilt and responsibility in the donors in only a few cases (2% of donors from questionnaire data and 2 of the 23 donors interviewed). Grief occurred often (22 of 23 donors interviewed) and was often surprisingly intense, given the fact that the recipient was a stranger. Intensity of grief varied depending on the perceived relationship with the recipient. Our data indicate that limiting contact and/or information about the recipient to the donor would be unlikely to result in more positive psychosocial outcomes. However, several strategies which might be useful in relieving donor guilt and/or grief are suggested.
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Affiliation(s)
- V A Butterworth
- Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
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Dew MA, Simmons RG, Roth LH, Schulberg HC, Thompson ME, Armitage JM, Griffith BP. Psychosocial predictors of vulnerability to distress in the year following heart transplantation. Psychol Med 1994; 24:929-945. [PMID: 7892361 DOI: 10.1017/s0033291700029020] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study examines psychological symptomatology in a cohort of 72 heart transplant recipients followed longitudinally during their first year post-transplant. In keeping with research on other domains of life stressors and illnesses, a central study goal was to identify pre-transplant and perioperative psychosocial factors associated with increased vulnerability to, and maintenance of, elevated psychological distress levels post-transplant. Average anxiety and depression levels, but not anger-hostility symptoms, were substantially elevated in the early post-transplant period, relative to normative data. Average symptom levels improved significantly over time, although one-third of the sample continued to have high distress levels at all follow-up assessments. Recipients with any of seven psychosocial characteristics at initial interview were particularly susceptible to continued high average distress levels over time: a personal history of psychiatric disorder prior to transplant; younger age; lower social support from their primary family caregiver; exposure to recent major life events involving loss; poor self-esteem; a poor sense of mastery; and use of avoidance coping strategies to manage health problems. Recipients without such factors showed improvement in average distress levels across the assessment period. These effects were stronger for anxiety than depressive symptoms, with the exception of a sizeable relationship between loss events and subsequent depression. The findings suggest that clinical interventions designed to minimize prolonged emotional distress post-transplant need to be closely tailored to heart recipients' initial psychosocial assets and liabilities.
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Affiliation(s)
- M A Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA 15213
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