Womens Health Issues最新文献

Exploring the Experience of Pain and Pain Management for Pregnant and Postpartum Veterans With Chronic Musculoskeletal Pain. 探索患有慢性肌肉骨骼疼痛的怀孕和产后退伍军人的疼痛体验和疼痛管理。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-09-05 DOI: 10.1016/j.whi.2024.07.004

Aimee Kroll-Desrosiers, Kate F Wallace, Diana M Higgins, Steve Martino, Valerie Marteeny, Lorrie Walker, Kristin M Mattocks

Background: To examine how veterans experience and treat pain during the perinatal period, we conducted a qualitative study to explore the experiences of pain, pain management, and facilitators and barriers to treatment among perinatal veterans.

Methods: We identified veterans who received care at 1 of 15 Veterans Health Administration (VHA) facilities across the United States and were enrolled in an ongoing cohort study. All participants gave birth to a newborn between March 2016 and June 2021 and met the inclusion criteria for having a prepregnancy pain-related musculoskeletal condition. We completed interviews with 30 veterans between November 2021 and January 2022. We used a framework approach to our qualitative analysis.

Results: Veterans in our sample were, on average, 31 years of age, married (80%), and white (47%). The most common type of pain diagnoses were back pain (93%) and joint disorders (73%). We identified the following major themes: 1) veteran experiences of pain during pregnancy, 2) challenges to pain care during the perinatal period, and 3) veteran recommendations for VHA perinatal pain care. Experiences of pain during pregnancy varied and several barriers to pain care were identified. Veterans suggested several ways the VHA could improve pain care during the perinatal period, including more training for VHA providers on perinatal pain care and greater complementary and integrative health coverage.

Conclusions: Understanding the unique needs of pregnant veterans with chronic pain is important to provide high-quality care during the perinatal period. Veterans who participated in this study highlighted several areas where the VHA could improve pain management during pregnancy and postpartum.

背景：为了研究退伍军人在围产期如何经历和治疗疼痛，我们进行了一项定性研究，以探讨围产期退伍军人的疼痛经历、疼痛管理以及治疗的促进因素和障碍：我们确定了在全美 15 个退伍军人健康管理局（VHA）机构中的一个机构接受治疗的退伍军人，他们都参加了一项正在进行的队列研究。所有参与者都是在 2016 年 3 月至 2021 年 6 月期间分娩的新生儿，并符合孕前患有与疼痛相关的肌肉骨骼疾病的纳入标准。我们在 2021 年 11 月至 2022 年 1 月期间完成了对 30 名退伍军人的访谈。我们采用框架方法进行定性分析：样本中的退伍军人平均年龄为 31 岁，已婚（80%），白人（47%）。最常见的疼痛诊断类型是背痛（93%）和关节紊乱（73%）。我们确定了以下主要主题：1）退伍军人在怀孕期间的疼痛经历；2）围产期疼痛护理面临的挑战；3）退伍军人对退伍军人事务部围产期疼痛护理的建议。退伍军人在怀孕期间的疼痛经历各不相同，并发现了疼痛护理方面的一些障碍。退伍军人提出了退伍军人医疗管理局可以改善围产期疼痛护理的几种方法，包括对退伍军人医疗管理局的医护人员进行更多围产期疼痛护理方面的培训，以及扩大补充和综合保健的覆盖范围：结论：了解患有慢性疼痛的怀孕退伍军人的独特需求对于在围产期提供高质量的护理非常重要。参与本研究的退伍军人强调了退伍军人医疗管理局可以改进孕期和产后疼痛管理的几个方面。

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引用次数: 0

Hair and Health Among African American Women: Historical and Sociocultural Considerations for Physical Activity and Mental Health. 非裔美国妇女的头发与健康：体育活动和心理健康的历史和社会文化考量。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-09-03 DOI: 10.1016/j.whi.2024.07.005

Patricia O'Brien-Richardson

引用次数: 0

Barriers and Facilitators of Extended Use of the Contraceptive Implant: A Cross-Sectional Survey of Clinicians 延长使用避孕植入物的障碍和促进因素：临床医生横断面调查。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-09-01 DOI: 10.1016/j.whi.2024.04.003

Background

The U.S. Food and Drug Administration (FDA) approved the etonogestrel contraceptive implant for 3 years of use. Evidence suggests that it may be used for up to 5 years for pregnancy prevention, also known as extended use.

Methods

We conducted a national cross-sectional survey among a group of reproductive health clinicians. We developed an online survey using the Consolidated Framework for Implementation Research (CFIR) and distributed it through e-mail listservs and social media groups from May to June 2021. We analyzed results using multivariable logistical regression.

Results

Among the 300 respondents, 195 (65.0%) reported that they always offer extended use, and 50 (16.7%) reported that they sometimes offer extended use. Fifty-five respondents (18.3%) reported that they never offer extended use. After adjusting for age, gender, and clinical setting, we found that complex family planning sub-specialists (adjusted odds ratio [aOR] = 9.32; 95% confidence interval [CI] [1.81, 48.03]) and family medicine physicians (aOR = 4.37, 95% CI [1.58, 12.10]) were significantly more likely to recommend extended use compared with general obstetrics and gynecology (OBGYN) physicians. Clinicians from private practices or health maintenance organizations were significantly less likely to offer extended use than those from academic centers (aOR = 0.19, 95% CI [0.07, 0.51]; aOR = 0.06, 95% CI [0.01, 0.31]). The most common barriers to offering extended use were concerns about pregnancy risk, bleeding, and lack of FDA approval past 3 years. Meanwhile, clinicians identified strong published evidence supporting extended use as a key facilitator for offering it, and they perceived that prior counseling on extended use from a past clinician was a key facilitator for patients to adopt it.

Conclusions

One-third of clinicians in this study did not consistently offer extended use of the contraceptive implant. An opportunity exists to expand access to extended use by focusing on education interventions for clinicians and seeking FDA approval for 5 years of use.

背景：美国食品和药物管理局（FDA）批准依托孕烯避孕植入物的使用期限为 3 年。有证据表明，它可用于避孕长达 5 年，也称为延长使用期：我们对一组生殖健康临床医生进行了一次全国性横断面调查。我们使用 "实施研究综合框架"（CFIR）开发了一项在线调查，并于 2021 年 5 月至 6 月通过电子邮件列表服务和社交媒体群组进行了发布。我们使用多变量逻辑回归对结果进行了分析：在 300 名受访者中，195 人（65.0%）表示他们总是提供扩展使用，50 人（16.7%）表示他们有时提供扩展使用。55 名受访者（18.3%）表示他们从不提供延长使用时间的服务。在对年龄、性别和临床环境进行调整后，我们发现与普通妇产科（OBGYN）医生相比，复合计划生育亚专科医生（调整后的几率比 [aOR] = 9.32；95% 置信区间 [CI] [1.81，48.03]）和全科医生（aOR = 4.37，95% CI [1.58，12.10]）更倾向于推荐延长使用时间。私人诊所或健康维护组织的临床医生提供延长用药的可能性明显低于学术中心的临床医生（aOR = 0.19，95% CI [0.07，0.51]；aOR = 0.06，95% CI [0.01，0.31]）。提供延期使用最常见的障碍是担心妊娠风险、出血以及过去 3 年未获得 FDA 批准。同时，临床医生认为，已发表的支持延长用药时间的有力证据是提供延长用药时间的主要促进因素，他们认为，过去的临床医生就延长用药时间提供的咨询是患者采用延长用药时间的主要促进因素：本研究中三分之一的临床医生没有坚持提供避孕植入物的延长使用。通过重点对临床医生进行教育干预，并寻求美国食品及药物管理局批准 5 年使用期，扩大延长使用期的机会是存在的。

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引用次数: 0

Facilitators and Barriers to Medicaid Doula Benefit Implementation in California: Perspectives From Managed Care Plans and Risk-Bearing Organizations 加利福尼亚州实施医疗补助 Doula 福利的促进因素和障碍：来自管理性医疗计划和风险承担组织的观点。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-09-01 DOI: 10.1016/j.whi.2024.05.006

Introduction

Medicaid coverage of doula services is increasing as a policy strategy to reduce maternal health inequities in the United States. However, early adopter states struggled to offer accessible, equitable Medicaid doula benefits when implementation began. California began covering doula services through its Medicaid program, Medi-Cal, in 2023. Managed care plans (MCPs) and risk-bearing organizations (RBOs) play an important role in ensuring pregnant and birthing people can access doula support through Medicaid benefits.

Materials and Methods

Between 2021 and 2022, we conducted 14 interviews with MCP and RBO staff (n = 20) representing a total of 14 MCPs and RBOs. Data were analyzed in two stages: 1) rapid assessment process and 2) using the Consolidated Framework for Implementation Research (CFIR) to identify specific facilitators and barriers to Medi-Cal doula benefit implementation.

Results

We identified 10 facilitators and 16 barriers across the five CFIR domains. Results indicate a general lack of familiarity with doula care and highlight the importance of relationship building with doulas and collaboration among plans.

Conclusions

In California, these findings can help guide improvements to emerging implementation challenges and evaluation efforts. Our findings can also help other states in the planning and Medicaid doula benefit design process.

导言：在美国，作为减少孕产妇健康不平等的一项政策策略，朵拉服务的医疗补助范围正在不断扩大。然而，早期采用该政策的各州在开始实施时都在努力提供方便、公平的医疗补助朵拉福利。加利福尼亚州于 2023 年开始通过其医疗补助计划 Medi-Cal 涵盖朵拉服务。管理性护理计划（MCPs）和风险承担组织（RBOs）在确保孕妇和分娩者能够通过医疗补助福利获得朵拉支持方面发挥着重要作用：在 2021 年至 2022 年期间，我们对 MCP 和 RBO 的工作人员（n = 20）进行了 14 次访谈，他们共代表了 14 家 MCP 和 RBO。数据分析分为两个阶段：1）快速评估过程；2）使用实施研究综合框架（CFIR）确定 Medi-Cal 朵拉福利实施的具体促进因素和障碍：我们在 CFIR 的五个领域中识别出了 10 个促进因素和 16 个障碍。结果表明，人们对朵拉护理普遍缺乏了解，并强调了与朵拉建立关系及计划间合作的重要性：在加利福尼亚，这些发现有助于指导改善新出现的实施挑战和评估工作。我们的发现也有助于其他州的规划和医疗补助朵拉福利设计过程。

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引用次数: 0

Suicidal Ideation and Suicide Attempts Among Women Veterans Using VA Reproductive Health Care: Prevalence and Associations With Fertility-, Pregnancy- and Parenting-related Factors 使用退伍军人协会生殖健康护理的女性退伍军人中的自杀意念和自杀企图：使用退伍军人协会生殖保健服务的女退伍军人中的自杀意念和自杀企图：流行率及其与生育、怀孕和养育子女相关因素的联系。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-09-01 DOI: 10.1016/j.whi.2024.06.004

Introduction

Women veterans are at elevated risk for suicide and experience a high prevalence of suicidal ideation (SI) and suicide attempt (SA) history. Knowledge regarding SI/SA correlates among women veterans who use reproductive health care services is limited, inhibiting development of evidence-based, gender-sensitive suicide prevention programming tailored to meet women veterans’ needs and preferences. This study aimed to 1) describe the prevalence and characteristics of SI and SA among women veterans using Veterans Health Administration (VHA) reproductive health care services and 2) provide an initial exploration of associations between fertility-, pregnancy-, and parenting-related factors with SI and SA to guide future research.

Methods

Post-9/11 women veterans (n = 352) who used VHA reproductive health care in fiscal year 2018 completed a cross-sectional survey on reproductive health, mental health, and parenting.

Results

Approximately 30% and 12% experienced SI and SA(s), respectively, after military service; 10% reported past-month SI. Infertility, pregnancy loss, age at first pregnancy, and parental status were not significantly associated with SI or SA history, although notable effect sizes were observed for infertility and age at first pregnancy; further research is warranted. Among parents, parental functioning was not associated with SI/SA, but lower parental satisfaction was significantly associated with past-month SI (prevalence ratio, 3.36; 95% confidence interval, 1.19–9.46; adjusting for demographics, military characteristics, mental health symptoms).

Conclusions

Postmilitary SI and SA(s) are common among women veterans accessing VHA reproductive health care services. Those with low parental satisfaction may be at particularly high risk. Findings can guide future research and inform clinical care to facilitate suicide prevention.

导言：女性退伍军人的自杀风险较高，自杀意念（SI）和自杀未遂（SA）的发生率也很高。人们对使用生殖健康护理服务的女性退伍军人的自杀意念/自杀未遂相关情况了解有限，这阻碍了针对女性退伍军人的需求和偏好制定循证的、对性别问题有敏感认识的自杀预防计划。本研究旨在：1）描述使用退伍军人健康管理局（VHA）生殖保健服务的女性退伍军人中SI和SA的发生率和特征；2）初步探讨生育、怀孕和养育子女相关因素与SI和SA之间的关联，以指导未来的研究：2018财年使用VHA生殖健康护理的9/11后女性退伍军人（n = 352）完成了一项关于生殖健康、心理健康和养育子女的横断面调查：大约 30% 和 12% 的人在服兵役后分别经历过 SI 和 SA（s）；10% 的人报告了过去一个月的 SI。不孕症、妊娠失败、首次怀孕年龄和父母状况与 SI 或 SA 史无显著关联，但在不孕症和首次怀孕年龄方面观察到明显的效应大小；需要进一步研究。在父母中，父母的功能与 SI/SA 无关，但较低的父母满意度与过去一个月的 SI 显著相关（患病率比为 3.36；95% 置信区间为 1.19-9.46；已对人口统计学、军事特征、心理健康症状进行调整）：结论：在接受退伍军人事务部生殖健康护理服务的女性退伍军人中，退伍后SI和SA（s）很常见。父母满意度低的女性退伍军人的风险尤其高。研究结果可指导未来的研究，并为临床护理提供信息，以促进自杀预防。

{"title":"Suicidal Ideation and Suicide Attempts Among Women Veterans Using VA Reproductive Health Care: Prevalence and Associations With Fertility-, Pregnancy- and Parenting-related Factors","authors":"","doi":"10.1016/j.whi.2024.06.004","DOIUrl":"10.1016/j.whi.2024.06.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Women veterans are at elevated risk for suicide and experience a high prevalence of suicidal ideation (SI) and suicide attempt (SA) history. Knowledge regarding SI/SA correlates among women veterans who use reproductive health care services is limited, inhibiting development of evidence-based, gender-sensitive suicide prevention programming tailored to meet women veterans’ needs and preferences. This study aimed to 1) describe the prevalence and characteristics of SI and SA among women veterans using Veterans Health Administration (VHA) reproductive health care services and 2) provide an initial exploration of associations between fertility-, pregnancy-, and parenting-related factors with SI and SA to guide future research.</p></div><div><h3>Methods</h3><p>Post-9/11 women veterans (<em>n</em> = 352) who used VHA reproductive health care in fiscal year 2018 completed a cross-sectional survey on reproductive health, mental health, and parenting.</p></div><div><h3>Results</h3><p>Approximately 30% and 12% experienced SI and SA(s), respectively, after military service; 10% reported past-month SI. Infertility, pregnancy loss, age at first pregnancy, and parental status were not significantly associated with SI or SA history, although notable effect sizes were observed for infertility and age at first pregnancy; further research is warranted. Among parents, parental functioning was not associated with SI/SA, but lower parental satisfaction was significantly associated with past-month SI (prevalence ratio, 3.36; 95% confidence interval, 1.19–9.46; adjusting for demographics, military characteristics, mental health symptoms).</p></div><div><h3>Conclusions</h3><p>Postmilitary SI and SA(s) are common among women veterans accessing VHA reproductive health care services. Those with low parental satisfaction may be at particularly high risk. Findings can guide future research and inform clinical care to facilitate suicide prevention.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386724000604/pdfft?md5=1a7585562ff6073259e620f4bcd87374&pid=1-s2.0-S1049386724000604-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

“It Feels Like Health Care with the Patient in Mind”: VA Patient and Staff Perspectives on Self-Collected HPV Testing "以患者为中心的医疗服务"：退伍军人事务部患者和工作人员对自采 HPV 检测的看法。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-09-01 DOI: 10.1016/j.whi.2024.05.003

Purpose

Self-collected testing for human papillomavirus (HPV) is poised to transform cervical cancer screening. Self-tests demonstrate similar accuracy to clinician-collected tests, but for the half a million women served by the Veterans Health Administration (VA) and their clinicians, self-collected cervical cancer screening would be a new practice. We examined VA patient and staff perspectives to inform future implementation.

Methods

Semi-structured telephone interviews were conducted between 2021 and 2022 with female veterans receiving VA care (n = 22) and VA women's health nurses, clinicians, and administrators (n = 27). Interviews were audio-recorded and transcribed. Interview questions addressed knowledge and interest, potential advantages or disadvantages, and any questions participants had about self-collected screening. Responses were analyzed using rapid qualitative methods.

Main findings

Five overarching themes were identified. Both patients and staff indicated high interest and enthusiasm for self-collected HPV testing, tempered by questions about test accuracy and logistical considerations. Familiarity with self-testing for other conditions such as colon-cancer screening or COVID made self-collection seem like a simple, convenient option. However, self-testing was not viewed as a good fit for all patients, and concerns about lost opportunities or missed incidental lesions were raised. Patients and staff described challenges with pelvic examinations for patients with past sexual trauma, particularly in the male-dominated VA environment. Pelvic exams can leave patients feeling vulnerable and exposed; self-collected testing was seen as a mechanism for patient empowerment.

Principal conclusions

Veteran patients and VA staff shared common perspectives about potential advantages and disadvantages of self-collected HPV testing. Self-collected HPV testing has the potential to improve trauma-informed preventive health care for veterans.

目的：人乳头瘤病毒（HPV）自采检测有望改变宫颈癌筛查。自我检测的准确性与临床医生采集的检测结果相似，但对于退伍军人健康管理局（VA）及其临床医生服务的 50 万妇女来说，自我采集宫颈癌筛查将是一种新的做法。我们研究了退伍军人健康管理局患者和工作人员的观点，为今后的实施提供参考：2021 年至 2022 年期间，我们对接受退伍军人事务部护理的女性退伍军人（22 人）以及退伍军人事务部妇女健康护士、临床医生和管理人员（27 人）进行了半结构化电话访谈。访谈进行了录音和转录。访谈问题涉及知识和兴趣、潜在的优势或劣势，以及参与者对自采筛查的任何疑问。采用快速定性方法对访谈结果进行了分析：主要结果：确定了五个重要主题。患者和医务人员都对自取式 HPV 检测表现出极大的兴趣和热情，但同时也存在检测准确性和后勤方面的问题。由于对结肠癌筛查或 COVID 等其他疾病的自我检测非常熟悉，自我检测似乎是一种简单、方便的选择。然而，并非所有患者都适合进行自我检测，有人担心会失去机会或错过偶然病变。患者和医务人员描述了对既往有性伤害的患者进行盆腔检查所面临的挑战，尤其是在男性主导的退伍军人事务部环境中。盆腔检查会让患者感到脆弱和暴露；自采检查被视为患者赋权的一种机制：退伍军人患者和退伍军人事务部的工作人员对自取式 HPV 检测的潜在利弊有着共同的看法。自取式 HPV 检测有可能改善退伍军人的创伤知情预防保健。

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引用次数: 0

Health Care Provider Willingness to Recommend Self-collected Tests for Human Papillomavirus: A Mixed Methods Examination of Associated Factors 医疗服务提供者推荐自采人类乳头瘤病毒检测的意愿：相关因素的混合方法研究。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-09-01 DOI: 10.1016/j.whi.2024.05.005

Introduction

Cervical cancer disproportionately affects those who are underscreened. Human papillomavirus self-collection is a promising tool to expand screening.

Objective

Study objectives were to examine 1) factors (provider characteristics and practice type) associated with and 2) attitudes (perceived benefits and concerns) toward using human papillomavirus self-collection for cervical cancer screening in clinical practice.

Methods

This study had a mixed method design; prior to regulatory approval of self-collection, we conducted a national survey and interviews of health care providers who perform cervical cancer screening. Quantitative measures included provider and practice characteristics, willingness to recommend, and preferences related to self-collection. Qualitative interviews further elucidated provider perspectives.

Results

A total of 1,251 providers completed surveys, and 56 completed interviews. Among survey respondents, 33.4% reported they were likely to offer self-collection, 28.6% were unsure, and 38.0% reported they were unlikely. Most would offer self-collection either in the clinic or at home per patient preference. Male participants, advanced practice providers, internal and family physicians, and those practicing in academic medical center, hospital, or community health settings were more likely than female participants, obstetrician–gynecologist physicians, and those in private practice to indicate they were likely to offer self-collection. Concerns expressed in both surveys and interviews included the adequacy of sample collection and the ability to follow up. Respondents felt that self-collection would be particularly beneficial for those who did not have access to clinician-collected screening, as well as for patients who may have difficulty with pelvic examinations for any reason.

Conclusion

Providers considered human papillomavirus self-collection to be a way to expand access for patients with health care barriers and pelvic examination difficulties. They had concerns related to sample adequacy and follow-up after abnormal results.

导言：宫颈癌对筛查不足者的影响尤为严重。人乳头状瘤病毒自我收集是扩大筛查范围的一种有前途的工具：研究目的：研究 1）与在临床实践中使用人乳头瘤病毒自检进行宫颈癌筛查相关的因素（提供者特征和实践类型）和 2）对使用人乳头瘤病毒自检进行宫颈癌筛查的态度（感知到的益处和担忧）：本研究采用混合方法设计；在监管部门批准自取病毒之前，我们对从事宫颈癌筛查的医疗服务提供者进行了一次全国性调查和访谈。定量测量包括医疗服务提供者和医疗实践的特点、推荐意愿以及与自我采集相关的偏好。定性访谈进一步阐明了医疗服务提供者的观点：共有 1,251 名医疗服务提供者完成了调查，56 人完成了访谈。在调查对象中，33.4% 的人表示他们有可能提供自我采血服务，28.6% 的人表示不确定，38.0% 的人表示不太可能。大多数人会根据患者的偏好在诊所或家中提供自我采血服务。与女性参与者、妇产科医生和私人医生相比，男性参与者、高级医疗服务提供者、内科医生和家庭医生以及在学术医疗中心、医院或社区卫生机构执业的医生更有可能表示他们有可能提供自我采血服务。调查和访谈中表达的担忧包括样本采集的充分性和随访能力。受访者认为，自我采集对于那些无法接受临床医生采集筛查的患者以及因各种原因难以接受盆腔检查的患者尤其有益：医疗服务提供者认为人类乳头瘤病毒自采筛查是扩大有医疗保健障碍和盆腔检查困难的患者筛查机会的一种方法。他们对样本的充分性和异常结果后的随访表示担忧。

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引用次数: 0

Development and Evaluation of a Novel Approach to Patient-Centered Contraceptive Counseling 开发和评估以患者为中心的避孕咨询新方法。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-09-01 DOI: 10.1016/j.whi.2024.06.003

Objectives

We aimed to develop and evaluate a novel model, PHI CARE, that provides a standardized framework for shared decision-making in contraceptive counseling.

Methods

We developed the PHI CARE model with national experts, piloted it at three family planning clinics, and finalized it following additional patient and clinician review. We recruited pregnancy-capable people for an evaluation study via simulated contraceptive counseling and identified salient themes through inductive and deductive coding.

Results

Participants (n = 12) felt that counseling with the PHI CARE model was an improvement over previous counseling experiences and led to feelings of empowerment; participants did not feel pressured to decide about method use, felt in control during the conversation, and appreciated the absence of assumptions about their desires around pregnancy. Despite the standardized format, participants felt the counseling was individualized, “values-based,” and tailored to their preferences.

Conclusion

PHI CARE is a model to support clinicians and counselors in operationalizing the principles of shared decision-making in contraceptive counseling. Through standardization, PHI CARE allows for a more individualized experience for patients and addresses many critiques of traditional counseling.

Practice Implications

PHI CARE is a memorable, brief tool that can be used for patient-centered contraceptive counseling in any clinical encounter.

目的我们旨在开发和评估一种新型模式 PHI CARE，它为避孕咨询中的共同决策提供了一个标准化框架：方法：我们与国内专家共同开发了 PHI CARE 模型，并在三家计划生育诊所进行了试点，在对患者和临床医生进行更多审查后最终确定了 PHI CARE 模型。我们通过模拟避孕咨询招募了有怀孕能力的人参与评估研究，并通过归纳和演绎编码确定了突出主题：结果：参与者（n = 12）认为 PHI CARE 模式的咨询比以往的咨询经验有所改进，使他们感到自己有了权力；参与者在决定使用避孕方法时没有感到压力，在谈话过程中感到自己有控制权，并对没有假设他们对怀孕的愿望表示赞赏。尽管采用了标准化的形式，但参与者认为咨询是个性化的、"以价值观为基础 "的，而且是根据她们的喜好量身定制的：PHI CARE 是一种支持临床医生和咨询师在避孕咨询中落实共同决策原则的模式。通过标准化，PHI CARE 为患者提供了更加个性化的体验，并解决了许多对传统咨询的批评：PHI CARE 是一种令人难忘的简短工具，可在任何临床情况下用于以患者为中心的避孕咨询。

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引用次数: 0

Health and Health Care Use of American Indian/Alaska Native Women Veterans: A Scoping Review 美国印第安人/阿拉斯加原住民女退伍军人的健康和医疗保健使用情况：范围审查。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-09-01 DOI: 10.1016/j.whi.2024.07.003

Background

American Indian/Alaska Native (AI/AN) women serve in the U.S. military, use Veterans Health Administration (VA) health care, and reside in rural areas at the highest rates compared with other women veterans. However, little is known about their unique health care needs, access, and health care use.

Objective

We assessed the existing literature on the health and health care use of U.S. AI/AN women veterans.

Methods

Online databases were searched to identify studies. Study characteristics extracted included health care topic, study design, overall sample size and number of AI/AN women veterans, and funding source. We screened 1,508 publications for inclusion; 28 publications were ultimately retained.

Results

Health care access and use were the most common health care research topics (39%), followed by mental health (36%) and physical health (25%). Few studies considered the impact of rurality. Most studies found significant differences between AI/AN women veterans and other women veterans or AI/AN men veterans. Publication dates ranged from 1998 to 2023, with 71% published after 2010. The majority of studies (75%) were secondary analyses of extant health care data. More than three-quarters of studies (82%) were funded federally (e.g., VA). Many studies were based on VA administrative data, resulting in a gap in knowledge regarding AI/AN women veterans who are not eligible for, or choose not to use, VA health care.

Conclusion

Research to inform the health and health care of AI/AN women veterans is limited, especially in terms of known AI/AN and women veterans' prevalent health concerns (e.g., diabetes, hypertension), women's health and reproduction, and how AI/AN women veterans access, use, and confront barriers to health care. Moreover, there is scarce research specific to cultural, tribal, and regional factors that likely affect access and use of particular health care systems or that can affect perspectives on illness that impact long-term treatment adherence and patient outcomes.

背景：美国印第安人/阿拉斯加原住民（AI/AN）妇女在美国军队服役，使用退伍军人健康管理局（VA）的医疗服务，与其他女性退伍军人相比，她们居住在农村地区的比例最高。然而，人们对她们独特的医疗保健需求、获取途径和医疗保健使用情况知之甚少：我们评估了有关美国亚裔美国人/印第安人女性退伍军人的健康和医疗保健使用情况的现有文献：方法：搜索在线数据库以确定研究。提取的研究特征包括医疗保健主题、研究设计、总体样本大小、阿拉斯加原住民/印第安人女性退伍军人的人数以及资金来源。我们筛选了 1,508 篇出版物，最终保留了 28 篇：医疗保健的获取和使用是最常见的医疗保健研究主题（39%），其次是心理健康（36%）和身体健康（25%）。很少有研究考虑到农村地区的影响。大多数研究发现，阿拉斯加原住民/印第安人女性退伍军人与其他女性退伍军人或阿拉斯加原住民/印第安人男性退伍军人之间存在明显差异。这些研究的发表日期从 1998 年到 2023 年不等，其中 71% 的研究发表于 2010 年之后。大多数研究（75%）是对现有医疗数据的二次分析。超过四分之三的研究（82%）由联邦政府（如退伍军人事务部）资助。许多研究以退伍军人事务部的行政数据为基础，导致对不符合条件或选择不使用退伍军人事务部医疗服务的阿拉斯加原住民/印第安人女性退伍军人的了解存在差距：有关亚裔美国人/印第安人女性退伍军人的健康和医疗保健的研究十分有限，尤其是在已知的亚裔美国人/印第安人和女性退伍军人普遍关注的健康问题（如糖尿病、高血压）、女性健康和生殖，以及亚裔美国人/印第安人女性退伍军人如何获得、使用和面对医疗保健障碍等方面。此外，针对文化、部落和地区因素的研究也很少，这些因素可能会影响特定医疗保健系统的获取和使用，或者会影响对疾病的看法，从而影响长期治疗的坚持性和患者的治疗效果。

{"title":"Health and Health Care Use of American Indian/Alaska Native Women Veterans: A Scoping Review","authors":"","doi":"10.1016/j.whi.2024.07.003","DOIUrl":"10.1016/j.whi.2024.07.003","url":null,"abstract":"<div><h3>Background</h3><p>American Indian/Alaska Native (AI/AN) women serve in the U.S. military, use Veterans Health Administration (VA) health care, and reside in rural areas at the highest rates compared with other women veterans. However, little is known about their unique health care needs, access, and health care use.</p></div><div><h3>Objective</h3><p>We assessed the existing literature on the health and health care use of U.S. AI/AN women veterans.</p></div><div><h3>Methods</h3><p>Online databases were searched to identify studies. Study characteristics extracted included health care topic, study design, overall sample size and number of AI/AN women veterans, and funding source. We screened 1,508 publications for inclusion; 28 publications were ultimately retained.</p></div><div><h3>Results</h3><p>Health care access and use were the most common health care research topics (39%), followed by mental health (36%) and physical health (25%). Few studies considered the impact of rurality. Most studies found significant differences between AI/AN women veterans and other women veterans or AI/AN men veterans. Publication dates ranged from 1998 to 2023, with 71% published after 2010. The majority of studies (75%) were secondary analyses of extant health care data. More than three-quarters of studies (82%) were funded federally (e.g., VA). Many studies were based on VA administrative data, resulting in a gap in knowledge regarding AI/AN women veterans who are not eligible for, or choose not to use, VA health care.</p></div><div><h3>Conclusion</h3><p>Research to inform the health and health care of AI/AN women veterans is limited, especially in terms of known AI/AN and women veterans' prevalent health concerns (e.g., diabetes, hypertension), women's health and reproduction, and how AI/AN women veterans access, use, and confront barriers to health care. Moreover, there is scarce research specific to cultural, tribal, and regional factors that likely affect access and use of particular health care systems or that can affect perspectives on illness that impact long-term treatment adherence and patient outcomes.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Does a Welcoming Environment Influence Women Veterans’ Primary Care Experiences? 欢迎环境是否会影响女性退伍军人的初级保健体验？

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-09-01 DOI: 10.1016/j.whi.2024.07.002

Background

A welcoming environment may influence patient care experiences, and it may be particularly relevant for underrepresented groups, such as women veterans at Veterans Health Administration (VA) facilities where they represent only 8–10% of patients. Challenges to ensuring a welcoming environment for women veterans may include unwelcome comments from male veterans and staff or volunteers and feeling unsafe inside or outside VA facilities. We assessed associations between reports of gender-related environment of care problems and patient-reported outcomes.

Procedures

We merged national patient-reported outcomes from women veterans (n = 4,961) using Consumer Assessment of Health Plans & Systems Patient Centered Medical Home (CAHPS-PCMH) survey composite measures with Women Veteran Program Managers' reports of gender-related environment of care problems (n = 127, 2016–2017) at VA facilities. We performed multilevel bivariate logistic regressions to assess associations between Women Veteran Program Managers' reports of large/extreme problems and likelihood of women veterans’ optimal ratings of primary care experiences (access, coordination, comprehensiveness, provider communication, and overall rating of primary care provider). We adjusted for patient-, site-, and area-level characteristics, and clustering of patients within VA facilities, and we applied design weights to address nonresponse bias in the patient data. Response rates were 40% for women veterans and 90% for Women Veteran Program Managers.

Main Findings

Few (<15%) Women Veteran Program Managers reported large/extreme environment of care problems. Women veterans obtaining care at those sites were less likely to rate provider communication and comprehensiveness (psychosocial health assessed) as optimal.

Principal Conclusions

Ensuring a welcoming environment may improve women veterans' primary care experiences.

背景：温馨的环境可能会影响患者的护理体验，对于代表性不足的群体，例如退伍军人健康管理局设施中的女性退伍军人，她们仅占患者总数的 8-10%，这一点可能尤为重要。要确保为女性退伍军人营造一个温馨的环境所面临的挑战可能包括来自男性退伍军人、工作人员或志愿者的不受欢迎的评论，以及在退伍军人医疗机构内外感到不安全。我们评估了与性别相关的护理环境问题报告与患者报告结果之间的关联：我们将全国女性退伍军人（n = 4961）的患者报告结果与女性退伍军人项目经理对退伍军人事务部设施中与性别相关的护理环境问题的报告（n = 127，2016-2017 年）进行了合并。我们进行了多层次的双变量逻辑回归，以评估女性退伍军人项目管理人员报告的大型/极端问题与女性退伍军人对初级医疗体验（就医途径、协调性、全面性、提供者沟通以及对初级医疗提供者的总体评价）最佳评价的可能性之间的关联。我们对患者、医疗机构和地区层面的特征以及退伍军人医疗机构内的患者聚类进行了调整，并应用设计权重来解决患者数据中的非响应偏差。女退伍军人的回复率为 40%，女退伍军人项目经理的回复率为 90%：很少（主要结论：确保一个温馨的环境可以改善女性退伍军人的初级保健体验。

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引用次数: 0