Contraception最新文献

英文中文

Development of a novel scale to measure health care professionals’ patient-centered contraceptive counseling competency 开发一种新的量表来衡量卫生保健专业人员以病人为中心的避孕咨询能力。

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-11-01 DOI: 10.1016/j.contraception.2025.111284

Elizabeth Janiak ScD , Sarah L. Johns MPH , Lillian W. Acton MPH , Natasha M. Lerner DrPH MPA , Armide Storey MD , Katharine O. White MD MPH

Objectives

Standardized and valid assessment of the patient-centeredness of clinical care requires validated quality measures. Validated patient-reported measures of patient-centeredness exist, but provider-reported self-assessment measures are lacking. We aimed to fill this gap by developing a novel scale as part of Partners in Contraceptive Choice and Knowledge (PICCK), a statewide contraceptive access program in Massachusetts.

Study Design

We developed an initial pool of 82 candidate scale items through a review of existing measures of related constructs such as interpersonal bias, understanding of principles of Reproductive Justice (RJ), and best practices in counseling for health topics other than contraception. A panel of 8 experts (5 clinicians and 3 lay community members) rated the face validity of the candidate items using a modified Delphi method, reducing the pool to 57 items. The 57-item scale was fielded with a convenience sample of 103 contraceptive providers (clinicians, nurses, medical assistants, and health educators).

Results

We performed an exploratory factor analysis on 92 responses (11 responses dropped due to missing data). We utilized an oblique rotation to yield a 3-factor solution with a total of 25 items in three subscales measuring 1) patient-centered counseling behaviors, 2) cultural/structural competency for working with patients with diverse backgrounds, 3) agreement with principles of RJ. Internal consistency reliability of the scale was strong (Cronbach’s alpha>0.80).

Conclusions

The novel scale shows promise for future psychometric testing. Further development of this measure could yield a useful tool for quality assurance and impact evaluation of contraceptive access interventions.

目的：临床护理以患者为中心的标准化和有效评估需要有效的质量措施。存在有效的患者报告的以患者为中心的措施，但缺乏提供者报告的自我评估措施。我们的目标是通过开发一种新的量表来填补这一空白，作为避孕选择和知识合作伙伴（pick）的一部分，这是马萨诸塞州的一个全州范围的避孕获取计划。研究设计：通过对人际偏见、对生殖公正原则的理解以及除避孕以外的健康主题咨询的最佳实践等相关构式的现有测量方法的回顾，我们开发了82个候选量表项目的初始库。由8名专家组成的小组（5名临床医生和3名非专业社区成员）使用改进的德尔菲法对候选项目的表面效度进行评定，将库减少到57个项目。该量表共有57个条目，由103名避孕服务提供者（临床医生、护士、医疗助理和健康教育工作者）提供方便样本。结果：我们对92份回复进行了探索性因子分析（11份回复因数据缺失而丢失）。我们利用斜向旋转得到了一个三因素解决方案，在三个子量表中共有33个项目，测量1)以患者为中心的咨询行为，2)与不同背景的患者一起工作的文化/结构能力，3)与RJ原则的一致性。量表的内部一致性信度较强（Cronbach's alpha>0.80）。结论：新的量表为未来的心理测试提供了前景。这一措施的进一步发展可为获得避孕措施的质量保证和影响评价提供一个有用的工具。

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引用次数: 0

Contraceptive effectiveness: A synthesis of the literature 避孕效果：文献综合。

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-31 DOI: 10.1016/j.contraception.2025.111282

Chelsea B. Polis , Sarah E.K. Bradley , Elizabeth A. Micks , Markus J. Steiner

引用次数: 0

Postpartum permanent contraceptive procedures: A 360-degree qualitative investigation 产后永久避孕程序：360度定性调查。

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-30 DOI: 10.1016/j.contraception.2025.111281

Kathryn Crofton , Amelia Johnston , Savannah Kaszubinski , Sarah J. Betstadt , Elana Tal , Rachel Flink-Bochacki

Objectives

To explore interdisciplinary factors affecting completion of postpartum permanent contraceptive procedures (PPC) after vaginal delivery.

Study design

We conducted a multi-center qualitative study surrounding completion or non-completion of PPC at three academic institutions from July 2023-March 2024. We recruited patients who desired permanent contraceptive procedures following vaginal delivery. We conducted semi-structured interviews with patients and their nursing, obstetric, and anesthesia teams. With pre-identified areas of inquiry including barriers and facilitators, as well as inductive coding in Dedoose, we used a grounded theory approach to thematic analysis, concluding data collection after thematic saturation.

Results

We interviewed 19 patients (11 completed and eight non-completed procedures) and completed 49 staff interviews (mean 2.5/patient). We identified three major themes: (1) The antenatal focus on overcoming obstacles to PPC completion can overshadow standard perioperative counseling and hinder procedure fulfillment; (2) Healthcare workers’ personal values influence their motivation to ensure these procedures are completed; (3) Obstacles are similar for completed and noncompleted procedures, with the difference often being a champion to optimize interdisciplinary collaboration and advocate for care.

Conclusions

Unlike most surgeries, the completion of PPC centers around overcoming barriers (such as operating room availability and healthcare team motivation), rather than patient needs. The propensity for clinician advocacy to detract from perioperative patient care is a novel finding, and it sustains a culture where contraceptive requests are actualized based on care-team factors rather than patient needs. Ultimately, the discretionary nature of procedure fulfillment invites bias and hinders patient-centered care.

Implications

Interdisciplinary, systems-level solutions are necessary to improve the fulfillment of desired postpartum permanent contraceptive procedures. Centering counseling and practices around patients’ informational and care needs as opposed to healthcare team values and limitations could improve both provision and quality of postpartum contraceptive care.

目的：探讨影响阴道分娩后完成产后永久避孕手术（PPC）的多学科因素。研究设计：我们于2023年7月至2024年3月在三所学术机构进行了一项围绕PPC完成或未完成的多中心定性研究。我们招募了希望在阴道分娩后进行永久性避孕手术的患者。我们对患者及其护理、产科和麻醉团队进行了半结构化访谈。通过预先确定的调查领域，包括障碍和促进因素，以及Dedoose中的归纳编码，我们使用了基于理论的方法进行主题分析，在主题饱和后总结数据收集。结果：我们采访了19例患者（11例完成手术，8例未完成手术），完成了49次工作人员访谈（平均2.5次/例）。我们确定了三个主要主题：(1)产前对PPC完成障碍的关注可能会掩盖标准的围手术期咨询并阻碍程序的完成；(2)医护人员的个人价值观影响其完成这些程序的动机；(3)完成和未完成程序的障碍相似，不同之处在于，往往是优化跨学科合作和倡导护理的倡导者。结论：与大多数手术不同，PPC的完成主要围绕克服障碍（如手术室的可用性和医疗团队的动机），而不是患者的需求。临床医生的倡导倾向于减少围手术期患者的护理是一个新的发现，它维持了一种文化，在这种文化中，避孕要求是基于护理团队的因素而不是患者的需要来实现的。最终，程序履行的自由裁量性质会引起偏见并阻碍以患者为中心的护理。意义：跨学科，系统级的解决方案是必要的，以提高实现所需的产后永久避孕程序。以患者的信息和护理需求为中心的咨询和实践，而不是医疗团队的价值观和局限性，可以改善产后避孕护理的提供和质量。

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引用次数: 0

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-29 DOI: 10.1016/S0010-7824(25)00451-2

引用次数: 0

Contraceptive safety in liver disease: The cost of overstating risk 肝病的避孕安全：夸大风险的代价

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-29 DOI: 10.1016/j.contraception.2025.110974

Meera Garriga, Marcelle Cedars, Sara Whetstone, Monika Sarkar

引用次数: 0

Response to: "Contraceptive safety in liver disease: The cost of overstating risk" 对“肝病的避孕安全：夸大风险的代价”的回应

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-29 DOI: 10.1016/j.contraception.2025.111048

Chadakarn Phaloprakarn, Siriwan Tangjitgamol, Supatsri Sethasine, Sasiwan Suthasmalee

引用次数: 0

Improving, expanding, and scaling contraceptive access efforts 改进、扩大和扩大避孕药具获取工作。

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-28 DOI: 10.1016/j.contraception.2025.111280

Jessica Danaux, Jamie Hart

引用次数: 0

State-level policy options for expanding coverage and affordability of over-the-counter contraceptives in the United States 扩大美国非处方避孕药具的覆盖面和可负担性的州级政策选择

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-27 DOI: 10.1016/j.contraception.2025.111250

Adam Sonfield , Dana Singiser

The introduction of over-the-counter (OTC) oral contraceptive pills to the U.S. market has the potential to expand contraceptive access. Still, current federal policy sets up a significant barrier by allowing health insurers to require a medically unnecessary prescription as a condition of covering the drug. State policymakers have explored multiple strategies for eliminating or mitigating the coverage barrier for state residents, including those with state-regulated private insurance, Medicaid, and coverage for public employees and students at public universities and colleges. In this commentary, we explain the scope and limits of state authority, provide examples of state actions to expand coverage and access to OTC contraceptives, and describe major considerations for state officials in designing, implementing, and overseeing new policies. These strategies serve as a roadmap for additional states seeking means to expand access to OTC contraception.

非处方（OTC）口服避孕药进入美国市场有可能扩大避孕途径。然而，目前的联邦政策设置了一个重大障碍，允许健康保险公司将医疗上不必要的处方作为承保这种药物的条件。州决策者已经探索了多种策略来消除或减轻州居民的覆盖障碍，包括那些拥有州监管的私人保险、医疗补助、公共雇员和公立大学和学院学生的保险。在本评论中，我们解释了国家权力的范围和限制，提供了国家为扩大OTC避孕药具的覆盖面和获取而采取的行动的例子，并描述了国家官员在设计、实施和监督新政策时的主要考虑因素。这些战略为其他寻求扩大OTC避孕手段的州提供了路线图。

引用次数: 0

Responsive design, local realities: A process evaluation of Family Planning Elevated 响应式设计，地方现实：计划生育提升的过程评价。

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-27 DOI: 10.1016/j.contraception.2025.111277

Jami Baayd, Caitlin Quade, Alexandra Gero, Jessica N. Sanders, Rebecca G. Simmons

Objectives

While the ability of contraceptive initiatives to improve access has been established, less is known about the process of implementing them within health settings. To address this gap, we conducted a process evaluation of Family Planning Elevated (FPE), a statewide contraceptive initiative in Utah.

Study design

FPE partnered with 28 clinics to provide no-cost contraceptive care to individuals across Utah. We conducted a mixed methods process evaluation to document how FPE was implemented, how surrounding context affected the implementation, and the mechanisms by which FPE created impact. Our primary data sources were baseline, midline, and endline focus groups with clinic staff, which we analyzed using the Consolidated Framework for Implementation Research and qualitative longitudinal analysis.

Results

Our evaluation yielded six themes: Utah’s reproductive health landscape (1) and the Covid pandemic (2) significantly impacted FPE’s implementation, (3) FPE’s adaptability was crucial to successful implementation, (4) structural characteristics of clinics were a common barrier to implementation, (5) clinic partners were motivated to participate in FPE, despite its complexity, because of the benefit to their clients and (6) provider perspectives and organizational culture became more person-centered during FPE.

Conclusions

Findings from FPE’s process evaluation point to the importance of designing a program that is adaptable to shifting local, state, and national context, as well as to the unique needs of each clinic. Clinic partners were committed to expanding contraceptive access through FPE, and during their participation, clinic staff’s perspectives shifted towards a more person-centered approach and culture.

Implications

Success of this initiative was driven by the ability of the FPE program to tailor the intervention to meet unique clinic and community needs, and by the commitment of clinic partners to expand contraceptive access for their clients.

目标：虽然已经确立了避孕措施改善获取的能力，但对在卫生机构内实施这些措施的过程了解较少。为了解决这一差距，我们对犹他州的一项全州范围内的避孕倡议——计划生育提升计划（FPE）进行了过程评估。研究设计：FPE与28家诊所合作，为犹他州的个人提供免费避孕护理。我们进行了一项混合方法过程评估，以记录FPE是如何实施的，周围环境是如何影响实施的，以及FPE产生影响的机制。我们的主要数据来源是基线、中线和终线焦点小组与诊所工作人员，我们使用实施研究统一框架和定性纵向分析进行分析。结果：我们的评估产生了六个主题：犹他州的生殖健康状况（1)和Covid大流行(2)显著影响了FPE的实施，3）FPE的适应性对成功实施至关重要，4)诊所的结构特征是实施的常见障碍，5)尽管FPE很复杂，但诊所合作伙伴仍有动力参与FPE，因为他们的客户受益，6)在FPE期间，提供者的观点和组织文化变得更加以人为中心。结论：FPE的过程评估结果表明，设计一个适应当地、州和国家环境变化的方案以及每个诊所的独特需求的重要性。诊所合作伙伴致力于通过FPE扩大避孕药具的获取，在他们参与期间，诊所工作人员的观点转向了更加以人为本的方法和文化。影响：这一举措的成功是由于FPE项目有能力定制干预措施以满足独特的诊所和社区需求，以及诊所合作伙伴承诺扩大其客户获得避孕药具的机会。

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引用次数: 0

Practical insights at a critical time: Lessons from Illinois on implementing family planning state plan amendments 关键时刻的实践洞察：伊利诺伊州实施计划生育州计划修订的经验教训

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2025-10-27 DOI: 10.1016/j.contraception.2025.111247

Kai Tao, Katie Thiede, Meg Lassar

Family planning Medicaid programs via state plan amendments can extend preventative care coverage to broader populations, generate cost savings for states, and safeguard against changes to Title X and to Medicaid and its financing structure. Contraceptive access initiatives, as subject matter experts and coalition builders, are uniquely positioned to serve as “systems orchestrators”, working across “the 4 Ps”—providers, patients, payers, and policymakers—to fulfill the promise of these policies to improve access to critical sexual and reproductive health services. Since 2021, ICAN! has played this role in Illinois. By providing technical assistance to state agencies, developing tailored trainings for diverse audiences of providers working in health center and community-based settings, and engaging patients through culturally responsive public awareness campaigns and digital tools, ICAN! has developed and implemented a family planning state plan amendment that may serve as a model for other states.

通过修订州计划，计划生育医疗补助计划可以将预防性医疗覆盖范围扩大到更广泛的人群，为各州节省成本，并防止第十条、医疗补助计划及其融资结构的变化。避孕药具获取行动作为主题专家和联盟建设者，具有独特的地位，可以作为“系统协调者”，跨“4p”（提供者、患者、付款人和政策制定者）开展工作，履行这些政策的承诺，改善获得关键的性健康和生殖健康服务的机会。自2021年起，ICAN！在伊利诺伊州扮演了这样的角色。通过向国家机构提供技术援助，为在卫生中心和社区环境中工作的提供者的不同受众开发量身定制的培训，以及通过响应文化的公共意识运动和数字工具吸引患者，ICAN！制定并实施计划生育国家计划修正案，对其他国家具有借鉴意义。

引用次数: 0

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