Womens Health Issues最新文献_第8页

Provider and Staff Perspectives on Screening and Referral for Social Determinants of Health During Perinatal Care: Implications Using the Consolidated Framework for Implementation Research 提供者和工作人员对围产期保健期间健康的社会决定因素的筛查和转诊的看法：使用实施研究的综合框架的含义。

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

Womens Health Issues

Pub Date : 2025-03-01 DOI: 10.1016/j.whi.2025.01.007

Sophia E. Allen MPH , Daisy J. Goodman DNP, MPH, CNM, CARN-AP , Taralyn Bielaski MPH , Sophia Sisson MPH , Chelsey R. Canavan MSPH , Ilana Cass MD , Beatrice Ngugi MSW , Catherine H. Saunders PhD, MPH , Alka Dev DrPH, MHS

Background

New federal mandates require universal screening and referral for social determinants of health (SDOHs), and evidence exists supporting its integration into primary care practice. However, implementation in maternity care remains understudied and underfunded. To inform maternal health practice, we studied clinical stakeholders' perspectives on SDOH screening and referral knowledge, priority, challenges, and opportunities across four hospital-affiliated obstetrics and gynecology clinics in New Hampshire.

Methods

We conducted 15 semistructured interviews and four focus groups (with 20 total group participants) to explore clinical providers’ and staff perspectives regarding the implementation of SDOH screening at their obstetrics clinics. We used the updated Consolidated Framework for Implementation Research to inform our interview and focus group guides. We identified our themes inductively using Practical Thematic Analysis.

Results

Participants represented nine different clinical and administrative roles. Four major themes culminated from the interviews and focus groups: 1) clinical staff identified clinic-specific workflows as critical to implementing the SDOH screening intervention; 2) clinical staff's workload and lack of training in SDOHs informed their level of commitment to SDOH screening and referral; 3) given many patients' extensive psychosocial needs, clinical staff wanted dedicated resources and time to respond to screening results; and 4) clinical staff perceived that SDOH screening impacts the patient experience, with the potential to decrease stigma depending on how screening results are discussed.

Conclusions

Despite unanimous support for addressing SDOHs within maternity care, participants perceived persistent challenges to effectively implementing SDOH screening and providing adequate referrals. They recommended that screening for SDOHs in vulnerable populations be accompanied by clear guidance and leadership, equitable distribution of resources and staff time between implementing clinics, and continuous quality improvement efforts.

背景：新的联邦法令要求对健康的社会决定因素（SDOHs）进行普遍筛查和转诊，现有证据支持将其纳入初级保健实践。然而，在产妇保健方面的执行情况仍未得到充分研究和资金不足。为了向产妇保健实践提供信息，我们研究了新罕布什尔州四家医院附属妇产科诊所的临床利益相关者对SDOH筛查和转诊知识、优先事项、挑战和机遇的看法。方法：我们进行了15次半结构化访谈和4个焦点小组（共20名小组参与者），探讨临床提供者和工作人员对产科诊所实施SDOH筛查的看法。我们使用了更新的《实施研究综合框架》来为我们的访谈和焦点小组指南提供信息。我们使用实用主题分析来归纳确定主题。结果：参与者代表了九种不同的临床和管理角色。访谈和焦点小组最终确定了四个主要主题：1)诊所工作人员确定了诊所特定的工作流程对于实施SDOH筛查干预至关重要；2)临床工作人员的工作量和缺乏SDOH培训决定了他们对SDOH筛查和转诊的承诺程度；3)考虑到许多患者广泛的社会心理需求，临床工作人员需要专门的资源和时间来响应筛查结果；4)临床工作人员认为，SDOH筛查会影响患者体验，并有可能减少耻辱感，这取决于如何讨论筛查结果。结论：尽管在产科护理中一致支持解决SDOH问题，但参与者认为有效实施SDOH筛查和提供足够的转诊存在持续的挑战。他们建议，在脆弱人群中进行SDOHs筛查的同时，要有明确的指导和领导，在实施诊所之间公平分配资源和工作人员时间，并不断努力提高质量。

{"title":"Provider and Staff Perspectives on Screening and Referral for Social Determinants of Health During Perinatal Care: Implications Using the Consolidated Framework for Implementation Research","authors":"Sophia E. Allen MPH , Daisy J. Goodman DNP, MPH, CNM, CARN-AP , Taralyn Bielaski MPH , Sophia Sisson MPH , Chelsey R. Canavan MSPH , Ilana Cass MD , Beatrice Ngugi MSW , Catherine H. Saunders PhD, MPH , Alka Dev DrPH, MHS","doi":"10.1016/j.whi.2025.01.007","DOIUrl":"10.1016/j.whi.2025.01.007","url":null,"abstract":"<div><h3>Background</h3><div>New federal mandates require universal screening and referral for social determinants of health (SDOHs), and evidence exists supporting its integration into primary care practice. However, implementation in maternity care remains understudied and underfunded. To inform maternal health practice, we studied clinical stakeholders' perspectives on SDOH screening and referral knowledge, priority, challenges, and opportunities across four hospital-affiliated obstetrics and gynecology clinics in New Hampshire.</div></div><div><h3>Methods</h3><div>We conducted 15 semistructured interviews and four focus groups (with 20 total group participants) to explore clinical providers’ and staff perspectives regarding the implementation of SDOH screening at their obstetrics clinics. We used the updated Consolidated Framework for Implementation Research to inform our interview and focus group guides. We identified our themes inductively using Practical Thematic Analysis.</div></div><div><h3>Results</h3><div>Participants represented nine different clinical and administrative roles. Four major themes culminated from the interviews and focus groups: 1) clinical staff identified clinic-specific workflows as critical to implementing the SDOH screening intervention; 2) clinical staff's workload and lack of training in SDOHs informed their level of commitment to SDOH screening and referral; 3) given many patients' extensive psychosocial needs, clinical staff wanted dedicated resources and time to respond to screening results; and 4) clinical staff perceived that SDOH screening impacts the patient experience, with the potential to decrease stigma depending on how screening results are discussed.</div></div><div><h3>Conclusions</h3><div>Despite unanimous support for addressing SDOHs within maternity care, participants perceived persistent challenges to effectively implementing SDOH screening and providing adequate referrals. They recommended that screening for SDOHs in vulnerable populations be accompanied by clear guidance and leadership, equitable distribution of resources and staff time between implementing clinics, and continuous quality improvement efforts.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 2","pages":"Pages 116-122"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531947","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

Obstetrician-Gynecologist Perspectives and Counseling Practices on the U.S. Medicaid Waiting Period for Permanent Contraception 美国医疗补助等待期永久避孕的妇产科医生观点和咨询实践。

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

Womens Health Issues

Pub Date : 2025-03-01 DOI: 10.1016/j.whi.2025.01.002

Suzanna Larkin MPH , Brooke W. Bullington BA , Kristen A. Berg PhD, CRC , Kari White PhD , Margaret Boozer MD , Tania Serna MD, MPH , Emily S. Miller MD, MPH , Jennifer L. Bailit MD, MPH , Kavita Shah Arora MD, MBE, MS

Background

Created to protect patients from coercive sterilization, the federally mandated 30-day waiting period for patients with Medicaid desiring permanent contraception is a known barrier to permanent contraception fulfillment. Existing research does not explicitly explore how physicians interpret and operationalize the consent policy, how they counsel regarding the waiting period, or whether physicians believe the policy should be revised. The purpose of this paper is to better understand obstetrician-gynecologist (OB-GYN) feelings, thoughts, and counseling practices around the waiting period as key stakeholders in counseling and provision of permanent contraception care.

Basic Procedures

We interviewed 81 postpartum people with a documented desire for permanent contraception and 61 OB-GYNs who delivered their infants at four hospitals across the United States. Interviews were audio-recorded, transcribed, and analyzed using rapid qualitative analysis and thematic content analysis.

Main Findings

Forty-seven physicians (70.2%) expressed negative feelings toward the Medicaid waiting period policy and 14 (20.9%) expressed neutral/mixed feelings. Physicians often viewed the Medicaid sterilization consent policy as inequitable and reported feeling that the waiting period hinders patient autonomy. Several physicians suggested that the waiting period needs revision. Physicians cited several barriers related to the implementation of the waiting period, including a lack of prenatal care or the conversation not being initiated. Physicians mentioned various approaches to counseling around the waiting period, either explicitly or inexplicitly explaining the policy. Last, physicians discussed differing interpretations around the waiting period policy.

Principal Conclusions

Physicians in our sample largely do not favor the current Medicaid sterilization waiting period. However, physicians report varying approaches to clinical counseling as well as beliefs regarding policy revision. Revision to the policy should be informed by the lived experience and expertise of the various stakeholders, including patients, clinicians, and policymakers.

背景：为了保护患者免于强制绝育，联邦政府强制要求获得永久避孕的患者30天的等待期是实现永久避孕的已知障碍。现有的研究没有明确探讨医生如何解释和操作同意政策，关于等待期的建议，或者医生是否认为该政策应该修改。本文的目的是为了更好地了解妇产科医生（OB-GYN）的感受，想法和咨询实践围绕等待期作为咨询和提供永久避孕护理的关键利益相关者。基本程序：我们采访了81名有永久避孕愿望的产后妇女和61名来自美国四家医院的妇产科医生。访谈录音、转录，并使用快速定性分析和主题内容分析进行分析。主要发现：47名医生（70.2%）对医疗补助等待期政策持负面态度，14名医生（20.9%）持中立或混合态度。医生们经常认为医疗补助计划的绝育同意政策是不公平的，并报告说，等待期阻碍了患者的自主权。一些医生建议，等待期需要修改。医生们列举了几个与等待期实施相关的障碍，包括缺乏产前护理或没有开始对话。医生们提到了等待期的各种咨询方法，或明确或不明确地解释了这项政策。最后，医生们讨论了对等待期政策的不同解释。主要结论：我们样本中的医生大多不赞成目前的医疗补助绝育等待期。然而，医生报告了不同的临床咨询方法以及关于政策修订的信念。政策的修订应根据包括患者、临床医生和政策制定者在内的各种利益攸关方的实际经验和专业知识。

{"title":"Obstetrician-Gynecologist Perspectives and Counseling Practices on the U.S. Medicaid Waiting Period for Permanent Contraception","authors":"Suzanna Larkin MPH , Brooke W. Bullington BA , Kristen A. Berg PhD, CRC , Kari White PhD , Margaret Boozer MD , Tania Serna MD, MPH , Emily S. Miller MD, MPH , Jennifer L. Bailit MD, MPH , Kavita Shah Arora MD, MBE, MS","doi":"10.1016/j.whi.2025.01.002","DOIUrl":"10.1016/j.whi.2025.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Created to protect patients from coercive sterilization, the federally mandated 30-day waiting period for patients with Medicaid desiring permanent contraception is a known barrier to permanent contraception fulfillment. Existing research does not explicitly explore how physicians interpret and operationalize the consent policy, how they counsel regarding the waiting period, or whether physicians believe the policy should be revised. The purpose of this paper is to better understand obstetrician-gynecologist (OB-GYN) feelings, thoughts, and counseling practices around the waiting period as key stakeholders in counseling and provision of permanent contraception care.</div></div><div><h3>Basic Procedures</h3><div>We interviewed 81 postpartum people with a documented desire for permanent contraception and 61 OB-GYNs who delivered their infants at four hospitals across the United States. Interviews were audio-recorded, transcribed, and analyzed using rapid qualitative analysis and thematic content analysis.</div></div><div><h3>Main Findings</h3><div>Forty-seven physicians (70.2%) expressed negative feelings toward the Medicaid waiting period policy and 14 (20.9%) expressed neutral/mixed feelings. Physicians often viewed the Medicaid sterilization consent policy as inequitable and reported feeling that the waiting period hinders patient autonomy. Several physicians suggested that the waiting period needs revision. Physicians cited several barriers related to the implementation of the waiting period, including a lack of prenatal care or the conversation not being initiated. Physicians mentioned various approaches to counseling around the waiting period, either explicitly or inexplicitly explaining the policy. Last, physicians discussed differing interpretations around the waiting period policy.</div></div><div><h3>Principal Conclusions</h3><div>Physicians in our sample largely do not favor the current Medicaid sterilization waiting period. However, physicians report varying approaches to clinical counseling as well as beliefs regarding policy revision. Revision to the policy should be informed by the lived experience and expertise of the various stakeholders, including patients, clinicians, and policymakers.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 2","pages":"Pages 83-88"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450683","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

Economic Insecurities and Mental Health Among Low-Income Pregnant People in the Central Valley Region of California 加州中央谷地区低收入孕妇的经济不安全感与心理健康

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

Womens Health Issues

Pub Date : 2025-03-01 DOI: 10.1016/j.whi.2025.01.006

Neha Zahid MPH , Bridgette Blebu PhD, MPH , Jennifer Felder PhD , Charles E. McCulloch PhD , Brittany D. Chambers PhD , Venise C. Curry MD , Kristin Carraway MPH , Daisy León-Martínez MD , Kimberly Coleman-Phox MPH , Miriam Kuppermann PhD, MPH , Deborah Karasek PhD, MPH

Background

The association between economic insecurity and mental health among low-income pregnant people is understudied. We examined the relationship between economic insecurity and perinatal stress, anxiety, and depressive symptoms among a low-income, racially/ethnically diverse study population, and differentiated associations by nativity status.

Methods

We used cross-sectional data from the EMBRACE Study that enrolled Medi-Cal (California's Medicaid program) eligible pregnant people in the Central Valley region of California. Economic insecurity was assessed through measures of food insecurity, low financial well-being, inability to pay an emergency expense, inability to pay bills, fear of eviction, and history of homelessness. We examined the association of these measures with perceived stress (Perceived Stress Scale), generalized anxiety symptoms (Generalized Anxiety Disorder-7), and depressive symptoms (Patient Health Questionnaire-9), adjusting for age, relationship status, and education level. We also examined effect measure modification by nativity among the Latinx population. We report the estimated differences and 95% confidence intervals for each exposure and outcome.

Results

In our sample of 674 participants, we observed associations between economic insecurity and mental health. Among the 24 models, 15 showed medium to large effects (>0.35 standard deviation differences) and only three showed negligible effect sizes. Across all outcomes, we observed a stronger relationship between economic insecurity and mental health for U.S.-born Latinx people compared with their foreign-born (93% Mexico-born) counterparts.

Conclusion

We found low-income pregnant people experience significant economic insecurities that may impact mental health adversely. Programs that increase economic supports during pregnancy may serve as important maternal mental health interventions, especially among racial/ethnic minoritized groups.

背景：低收入孕妇经济不安全感与心理健康之间的关系尚未得到充分研究。我们在低收入、种族/民族多样化的研究人群中研究了经济不安全感与围产期压力、焦虑和抑郁症状之间的关系，并通过出生状况区分了两者之间的关联。方法：我们使用了来自EMBRACE研究的横断面数据，该研究纳入了加州中央山谷地区符合Medi-Cal（加州医疗补助计划）条件的孕妇。经济不安全是通过粮食不安全、低财政福利、无力支付紧急费用、无力支付账单、害怕被驱逐和无家可归的历史来评估的。我们检查了这些测量与感知压力（感知压力量表）、广泛性焦虑症状（广泛性焦虑障碍-7）和抑郁症状（患者健康问卷-9）的关联，调整了年龄、关系状况和教育水平。我们还检查了拉丁裔人口中出生对效应测量的影响。我们报告了每个暴露和结果的估计差异和95%置信区间。结果：在674名参与者的样本中，我们观察到经济不安全感与心理健康之间的联系。在24个模型中，有15个模型显示出中大型效应（>.35个标准差差），只有3个模型的效应大小可以忽略不计。在所有结果中，我们观察到，与外国出生的拉丁裔（93%出生在墨西哥）相比，美国出生的拉丁裔人的经济不安全感与心理健康之间的关系更强。结论：我们发现低收入孕妇经历了严重的经济不安全感，这可能对心理健康产生不利影响。在怀孕期间增加经济支持的项目可以作为重要的孕产妇心理健康干预措施，特别是在种族/少数民族群体中。

{"title":"Economic Insecurities and Mental Health Among Low-Income Pregnant People in the Central Valley Region of California","authors":"Neha Zahid MPH , Bridgette Blebu PhD, MPH , Jennifer Felder PhD , Charles E. McCulloch PhD , Brittany D. Chambers PhD , Venise C. Curry MD , Kristin Carraway MPH , Daisy León-Martínez MD , Kimberly Coleman-Phox MPH , Miriam Kuppermann PhD, MPH , Deborah Karasek PhD, MPH","doi":"10.1016/j.whi.2025.01.006","DOIUrl":"10.1016/j.whi.2025.01.006","url":null,"abstract":"<div><h3>Background</h3><div>The association between economic insecurity and mental health among low-income pregnant people is understudied. We examined the relationship between economic insecurity and perinatal stress, anxiety, and depressive symptoms among a low-income, racially/ethnically diverse study population, and differentiated associations by nativity status.</div></div><div><h3>Methods</h3><div>We used cross-sectional data from the EMBRACE Study that enrolled Medi-Cal (California's Medicaid program) eligible pregnant people in the Central Valley region of California. Economic insecurity was assessed through measures of food insecurity, low financial well-being, inability to pay an emergency expense, inability to pay bills, fear of eviction, and history of homelessness. We examined the association of these measures with perceived stress (Perceived Stress Scale), generalized anxiety symptoms (Generalized Anxiety Disorder-7), and depressive symptoms (Patient Health Questionnaire-9), adjusting for age, relationship status, and education level. We also examined effect measure modification by nativity among the Latinx population. We report the estimated differences and 95% confidence intervals for each exposure and outcome.</div></div><div><h3>Results</h3><div>In our sample of 674 participants, we observed associations between economic insecurity and mental health. Among the 24 models, 15 showed medium to large effects (>0.35 standard deviation differences) and only three showed negligible effect sizes. Across all outcomes, we observed a stronger relationship between economic insecurity and mental health for U.S.-born Latinx people compared with their foreign-born (93% Mexico-born) counterparts.</div></div><div><h3>Conclusion</h3><div>We found low-income pregnant people experience significant economic insecurities that may impact mental health adversely. Programs that increase economic supports during pregnancy may serve as important maternal mental health interventions, especially among racial/ethnic minoritized groups.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 2","pages":"Pages 105-115"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469270","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

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

Womens Health Issues

Pub Date : 2025-03-01 DOI: 10.1016/j.whi.2024.12.001

Kathryn Laughon PhD, RN, FAAN , Rosemary B. Hughes PhD , Genevieve Lyons MSPH , Kana Roarty BSN, RN , Jeanne Alhusen PhD, CRNP, RN, FAAN

Background

Persons with disabilities are at higher risk of experiencing intimate partner violence (IPV) during the perinatal period than persons without disabilities. Although screening for IPV during the perinatal period is recommended by many organizations, little is known about screening rates for IPV by disability status.

Methods

Our objective was to compare rates of IPV screening during the perinatal period among persons with and without disabilities in the United States. A cross-sectional sample of 43,837 respondents provided data on disability, including difficulty in vision, hearing, ambulation, cognition, communication, and self-care. We conducted a secondary analysis of nationally representative data from the 2018–2020 Pregnancy Risk Assessment Monitoring System.

Results

During pregnancy, respondents with disabilities had a lower odds of IPV screening as compared with respondents without disabilities (adjusted odds ratio .83, 95% confidence interval [.70, .99]). Despite similar screening rates in the 12 months before conception and postpartum among respondents with and without disabilities who attended health care visits, those with disabilities were less likely to receive pregnancy-related care during pregnancy (p < .0001) and in the postpartum period (p < .0001) and thus missed opportunities to be screened.

Conclusion

Our findings demonstrate a need for health care providers to collaborate with policy makers, disability advocates, and researchers to reduce the disparities people with disabilities face in accessing health care, including screening for IPV during the perinatal period. Such efforts are essential for maximizing the health and safety of pregnant persons and new parents with disabilities and their children during the perinatal period.

背景：与非残疾人相比，残疾人在围产期遭受亲密伴侣暴力的风险更高。虽然许多组织建议在围产期进行IPV筛查，但对残疾状况的IPV筛查率知之甚少。方法：我们的目的是比较美国残疾人和非残疾人围产期IPV筛查率。43,837名受访者的横断面样本提供了有关残疾的数据，包括视力、听力、行走、认知、沟通和自我保健方面的困难。我们对2018-2020年妊娠风险评估监测系统中具有全国代表性的数据进行了二次分析。结果：在怀孕期间，残疾的调查对象接受IPV筛查的几率低于没有残疾的调查对象(调整优势比为0.83,95%可信区间[。70年,获得])。尽管在怀孕前12个月和产后参加医疗保健访问的残疾和非残疾受访者中，筛查率相似，但残疾人士在怀孕期间接受与妊娠有关的护理的可能性较小(p结论：我们的研究结果表明，卫生保健提供者需要与政策制定者、残疾人倡导者和研究人员合作，以减少残疾人在获得卫生保健方面面临的差距，包括围产期IPV筛查。这些努力对于最大限度地保障孕妇和残疾新生儿及其子女在围产期的健康和安全至关重要。

{"title":"Disability-Related Disparities in Screening for Intimate Partner Violence During the Perinatal Period: A Population-Based Study","authors":"Kathryn Laughon PhD, RN, FAAN , Rosemary B. Hughes PhD , Genevieve Lyons MSPH , Kana Roarty BSN, RN , Jeanne Alhusen PhD, CRNP, RN, FAAN","doi":"10.1016/j.whi.2024.12.001","DOIUrl":"10.1016/j.whi.2024.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Persons with disabilities are at higher risk of experiencing intimate partner violence (IPV) during the perinatal period than persons without disabilities. Although screening for IPV during the perinatal period is recommended by many organizations, little is known about screening rates for IPV by disability status.</div></div><div><h3>Methods</h3><div>Our objective was to compare rates of IPV screening during the perinatal period among persons with and without disabilities in the United States. A cross-sectional sample of 43,837 respondents provided data on disability, including difficulty in vision, hearing, ambulation, cognition, communication, and self-care. We conducted a secondary analysis of nationally representative data from the 2018–2020 Pregnancy Risk Assessment Monitoring System.</div></div><div><h3>Results</h3><div>During pregnancy, respondents with disabilities had a lower odds of IPV screening as compared with respondents without disabilities (adjusted odds ratio .83, 95% confidence interval [.70, .99]). Despite similar screening rates in the 12 months before conception and postpartum among respondents with and without disabilities who attended health care visits, those with disabilities were less likely to receive pregnancy-related care during pregnancy (<em>p</em> < .0001) and in the postpartum period (<em>p</em> < .0001) and thus missed opportunities to be screened.</div></div><div><h3>Conclusion</h3><div>Our findings demonstrate a need for health care providers to collaborate with policy makers, disability advocates, and researchers to reduce the disparities people with disabilities face in accessing health care, including screening for IPV during the perinatal period. Such efforts are essential for maximizing the health and safety of pregnant persons and new parents with disabilities and their children during the perinatal period.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 2","pages":"Pages 97-104"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956907","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

Addressing Weight Stigma in Perinatal Care: Strategies for Health Care Providers and Organizations 解决围产期护理中的体重污名：卫生保健提供者和组织的策略。

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

Womens Health Issues

Pub Date : 2025-01-01 DOI: 10.1016/j.whi.2024.11.002

Natalie M. Papini PhD , Taniya S. Nagpal PhD , Anna R. Whelan MD, FACOG , Tiffany A. Moore Simas MD, MPH, MEd , Molly E. Waring PhD

引用次数: 0

Abortion Provision at New York State Regional Perinatal Centers Following Implementation of the Reproductive Health Act 生殖健康法案》实施后纽约州地区围产中心提供的堕胎服务。

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

Womens Health Issues

Pub Date : 2025-01-01 DOI: 10.1016/j.whi.2024.10.001

Gopika R. Krishna MD , Julia E. Kohn PhD, MPA , Roselle Bleck MD, MPH , Carolyn L. Westhoff MD, MSc

Objective

Signed in 2019, New York State's Reproductive Health Act enabled expansion of abortion care up to 28 weeks for any indication. This study aimed to describe how implementation of the New York State Reproductive Health Act affected abortion provision among the state's regional perinatal centers (RPCs)—tertiary referral centers for complex pregnancies that may care for patients seeking abortion later in pregnancy. A secondary objective was to identify barriers to and facilitators of expanding abortion care.

Methods

From January to May 2023, we recruited clinicians from the 17 New York RPCs, including family planning specialists, maternal–fetal medicine specialists, and genetic counselors. Respondents completed an online survey. We then invited respondents to complete an in-depth interview. We calculated descriptive statistics to characterize the study population and summarize survey responses. We analyzed qualitative interview data using thematic analysis.

Results

Twenty-nine respondents completed the survey, representing 16 of 17 New York State RPCs. Seventeen respondents, representing 11 RPCs, completed an interview. All institutions provided abortion care. Twenty-three of 29 survey respondents (79%) reported barriers to providing abortion for any indication after 24 weeks from last menstrual period (LMP). Eighteen of 29 (62%) reported barriers to providing abortion after 24 weeks LMP for maternal or fetal indications. The most commonly reported barriers in the survey results were staff resistance and institutional policy. During interviews, respondents identified staff discomfort, restrictive institutional policies, and lack of clarity around policy as barriers, while highlighting advocates and collaboration within their institutions as facilitators to expansion of abortion services later in pregnancy.

Conclusions

RPCs in New York State face barriers in providing abortion, especially after 24 weeks LMP, even though they are ideally situated to provide such care. These barriers exist despite the legality of abortion after 24 weeks in New York and policy efforts to expand access to abortion.

目标：纽约州于 2019 年签署了《生殖健康法案》，该法案允许将任何适应症的人工流产护理时间延长至 28 周。本研究旨在描述《纽约州生殖健康法案》的实施如何影响该州区域围产中心（RPCs）的人工流产服务--这些中心是复杂妊娠的三级转诊中心，可为妊娠晚期寻求人工流产的患者提供护理。次要目标是确定扩大人工流产护理的障碍和促进因素：2023 年 1 月至 5 月，我们招募了纽约 17 家 RPC 的临床医生，包括计划生育专家、母胎医学专家和遗传咨询师。受访者完成了一项在线调查。然后，我们邀请受访者完成深度访谈。我们计算了描述性统计，以描述研究人群的特征并总结调查回复。我们使用主题分析法对定性访谈数据进行了分析：29 位受访者完成了调查，他们代表了纽约州 17 个区域协调中心中的 16 个。17 名受访者完成了访谈，他们代表了 11 家 RPC。所有机构都提供堕胎护理。29 位调查对象中有 23 位（79%）表示，在自末次月经期（LMP）起 24 周后提供任何适应症的人工流产服务存在障碍。29 个受访者中有 18 个（62%）表示在 LMP 24 周后因母体或胎儿原因提供人工流产服务存在障碍。调查结果中最常报告的障碍是工作人员的抵制和机构政策。在访谈中，受访者认为工作人员的不适、限制性的机构政策和政策不明确是障碍，同时强调机构内的倡导者和合作是扩大孕晚期人工流产服务的促进因素：纽约州的区域保健中心在提供人工流产服务方面面临障碍，尤其是在 LMP 24 周之后，尽管它们处于提供此类护理的理想位置。尽管在纽约州 24 周后堕胎是合法的，而且政策也在努力扩大堕胎服务，但这些障碍依然存在。

{"title":"Abortion Provision at New York State Regional Perinatal Centers Following Implementation of the Reproductive Health Act","authors":"Gopika R. Krishna MD , Julia E. Kohn PhD, MPA , Roselle Bleck MD, MPH , Carolyn L. Westhoff MD, MSc","doi":"10.1016/j.whi.2024.10.001","DOIUrl":"10.1016/j.whi.2024.10.001","url":null,"abstract":"<div><h3>Objective</h3><div>Signed in 2019, New York State's Reproductive Health Act enabled expansion of abortion care up to 28 weeks for any indication. This study aimed to describe how implementation of the New York State Reproductive Health Act affected abortion provision among the state's regional perinatal centers (RPCs)—tertiary referral centers for complex pregnancies that may care for patients seeking abortion later in pregnancy. A secondary objective was to identify barriers to and facilitators of expanding abortion care.</div></div><div><h3>Methods</h3><div>From January to May 2023, we recruited clinicians from the 17 New York RPCs, including family planning specialists, maternal–fetal medicine specialists, and genetic counselors. Respondents completed an online survey. We then invited respondents to complete an in-depth interview. We calculated descriptive statistics to characterize the study population and summarize survey responses. We analyzed qualitative interview data using thematic analysis.</div></div><div><h3>Results</h3><div>Twenty-nine respondents completed the survey, representing 16 of 17 New York State RPCs. Seventeen respondents, representing 11 RPCs, completed an interview. All institutions provided abortion care. Twenty-three of 29 survey respondents (79%) reported barriers to providing abortion for any indication after 24 weeks from last menstrual period (LMP). Eighteen of 29 (62%) reported barriers to providing abortion after 24 weeks LMP for maternal or fetal indications. The most commonly reported barriers in the survey results were staff resistance and institutional policy. During interviews, respondents identified staff discomfort, restrictive institutional policies, and lack of clarity around policy as barriers, while highlighting advocates and collaboration within their institutions as facilitators to expansion of abortion services later in pregnancy.</div></div><div><h3>Conclusions</h3><div>RPCs in New York State face barriers in providing abortion, especially after 24 weeks LMP, even though they are ideally situated to provide such care. These barriers exist despite the legality of abortion after 24 weeks in New York and policy efforts to expand access to abortion.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 1","pages":"Pages 7-13"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733385","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

Psychological and Social Predictors of Poverty: Differences Between Lesbian and Bisexual Women 贫困的心理和社会预测因素：女同性恋和双性恋女性之间的差异。

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

Womens Health Issues

Pub Date : 2025-01-01 DOI: 10.1016/j.whi.2024.10.004

Bianca D.M. Wilson PhD , Andy Lin PhD , Lauren J.A. Bouton MA

Purpose

Research has demonstrated that sexual minority populations are more likely to experience poverty than sexual majority populations and that many of these disparities are driven by specific sexual minority subgroups, including cisgender bisexual women. Yet, little is known about the factors associated with economic insecurity that explain the intragroup differences in economic outcomes among sexual minorities, particularly among those of the same gender (i.e., cisgender bisexual vs. lesbian women).

Methods

We used a U.S. national probability sample of non-transgender sexual minority adults to assess the relationship between poverty and demographic (age, race/ethnicity, education), psychological (psychological distress, self-acceptance, felt stigma, and experienced discrimination), and social (outness, partnership and parental status, partner gender, and gender expression) characteristics for each subgroup of women, lesbian/gay (n = 324) and bisexual (n = 355). We calculated odds ratios and adjusted odds ratios (AORs) estimated from logistic regression models that relate risk factors to poverty.

Results

Race/ethnicity (i.e., identifying as Black) and education (i.e., having a high school diploma or less) were associated with living in poverty for both groups. The role of minority stressors, such as outness, everyday discrimination, and internalized homophobia did not strongly predict poverty for either group. However, reports of experienced stigma related to one's sexual orientation and masculine gender expression were associated with poverty among lesbians but not for bisexual women, and having children was a strong predictor of poverty for bisexual women but not lesbians.

Conclusions

These findings suggest that policy, advocacy, and service interventions should consider tailoring approaches to address poverty for bisexual and lesbian women differently.

目的：研究表明，性少数群体比性多数群体更容易经历贫困，其中许多差异是由特定的性少数亚群体造成的，包括顺性双性恋女性。然而，人们对与经济不安全感相关的因素知之甚少，这些因素解释了性少数群体，特别是同性群体（即顺性双性恋与女同性恋女性）在经济结果上的群体内部差异。方法：我们使用美国全国非变性性少数成年人概率样本来评估贫困与人口统计学（年龄，种族/民族，教育），心理（心理困扰，自我接受，感觉耻辱和经历歧视）和社会（公开性，伴侣和父母地位，伴侣性别和性别表达）特征之间的关系，女同性恋/男同性恋（n = 324）和双性恋（n = 355）。我们计算了与贫困相关的风险因素的优势比，并调整了从逻辑回归模型估计的优势比（AORs）。结果：种族/民族（即认同为黑人）和教育（即拥有高中文凭或更低）与两个群体的贫困生活有关。少数族裔的压力因素，如外出、日常歧视和内化的同性恋恐惧症，并不能强烈地预测任何一个群体的贫困。然而，据报道，与性取向和男性化性别表达相关的耻辱经历与女同性恋者的贫困有关，而与双性恋女性无关；生孩子是双性恋女性贫困的有力预测指标，而与女同性恋无关。结论：这些研究结果表明，政策、宣传和服务干预措施应该考虑采用不同的方法来解决双性恋和女同性恋妇女的贫困问题。

{"title":"Psychological and Social Predictors of Poverty: Differences Between Lesbian and Bisexual Women","authors":"Bianca D.M. Wilson PhD , Andy Lin PhD , Lauren J.A. Bouton MA","doi":"10.1016/j.whi.2024.10.004","DOIUrl":"10.1016/j.whi.2024.10.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Research has demonstrated that sexual minority populations are more likely to experience poverty than sexual majority populations and that many of these disparities are driven by specific sexual minority subgroups, including cisgender bisexual women. Yet, little is known about the factors associated with economic insecurity that explain the intragroup differences in economic outcomes among sexual minorities, particularly among those of the same gender (i.e., cisgender bisexual vs. lesbian women).</div></div><div><h3>Methods</h3><div>We used a U.S. national probability sample of non-transgender sexual minority adults to assess the relationship between poverty and demographic (age, race/ethnicity, education), psychological (psychological distress, self-acceptance, felt stigma, and experienced discrimination), and social (outness, partnership and parental status, partner gender, and gender expression) characteristics for each subgroup of women, lesbian/gay (n = 324) and bisexual (n = 355). We calculated odds ratios and adjusted odds ratios (AORs) estimated from logistic regression models that relate risk factors to poverty.</div></div><div><h3>Results</h3><div>Race/ethnicity (i.e., identifying as Black) and education (i.e., having a high school diploma or less) were associated with living in poverty for both groups. The role of minority stressors, such as outness, everyday discrimination, and internalized homophobia did not strongly predict poverty for either group. However, reports of experienced stigma related to one's sexual orientation and masculine gender expression were associated with poverty among lesbians but not for bisexual women, and having children was a strong predictor of poverty for bisexual women but not lesbians.</div></div><div><h3>Conclusions</h3><div>These findings suggest that policy, advocacy, and service interventions should consider tailoring approaches to address poverty for bisexual and lesbian women differently.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 1","pages":"Pages 28-38"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787234","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

“Neither Side Really Knows… What an Abortion Is Like”: A Qualitative Analysis of Medical Students’ Experiences With Second-Trimester Procedural Abortions "双方都不知道......堕胎是什么样子"：医学生对第二孕期程序性流产经历的定性分析》。

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

Womens Health Issues

Pub Date : 2025-01-01 DOI: 10.1016/j.whi.2024.09.006

Kathryn Crofton MD, Rachel Flink-Bochacki MD, MPH, Brooke Zaiz MD, Johanna Bringley DO

Objectives

Medical students value abortion education; however, there has been little study regarding participation in second-trimester procedures, which are less common yet receive significant societal attention. We aimed to explore medical students’ perceptions of participation in second-trimester procedural abortions to optimize this educational experience.

Study Design

We conducted qualitative semi-structured interviews with third- and fourth-year medical students who voluntarily participated in second-trimester dilation and evacuation cases. We coded interviews inductively and performed thematic content analysis until thematic saturation was reached.

Participants

We interviewed 25 medical students, including 16 third-year and nine fourth-year students. Most participants were female (64%) and white (58%) and had no prior abortion care experience (80%).

Results

Four major themes emerged: 1) students felt unprepared for second-trimester procedural abortions and were unable to find adequate educational resources for preparation; 2) students experienced complex emotional reactions to the procedures, often finding the experience more challenging than expected; 3) students observed implicit expectations and biases in the learning environment; and 4) students highly valued their involvement in abortion procedures, noting that participation was important for their future practice and allowed acquisition of essential clinical skills.

Conclusions

Medical students value the educational opportunity to participate in second-trimester procedural abortions; however, most feel unprepared for the technical and emotional aspects, despite utilizing available educational resources. To maximize educational experience and psychological safety, educators should develop specialized training resources. This could strengthen physician knowledge and comfort with abortion care in the future, ultimately improving patient care.

目的：医学生重视人工流产教育；然而，有关参与第二孕期人工流产手术的研究却很少，因为这种手术并不常见，但却受到社会的广泛关注。我们旨在探讨医学生对参与第二孕期程序性流产的看法，以优化这一教育体验：研究设计：我们对自愿参与第二孕期扩张和排空手术的三年级和四年级医学生进行了半结构化定性访谈。我们对访谈进行了归纳编码，并进行了主题内容分析，直至达到主题饱和：我们对 25 名医学生进行了访谈，其中包括 16 名三年级学生和 9 名四年级学生。大多数参与者为女性（64%）和白人（58%），之前没有人工流产护理经验（80%）：结果：出现了四大主题：1）学生对第二孕期的程序性人工流产感到毫无准备，并且无法找到足够的教育资源进行准备；2）学生对人工流产过程经历了复杂的情绪反应，往往发现这种经历比预期更具挑战性；3）学生观察到学习环境中存在隐含的期望和偏见；以及 4）学生高度重视参与人工流产过程，指出参与人工流产过程对他们未来的实践非常重要，并且可以获得基本的临床技能：结论：医科学生重视参与第二孕期程序性人工流产的教育机会；然而，尽管利用了现有的教育资源，大多数学生仍感到在技术和情感方面准备不足。为了最大限度地提高教育体验和心理安全，教育者应开发专门的培训资源。这可以加强医生对人工流产护理的了解和舒适度，最终改善对患者的护理。

{"title":"“Neither Side Really Knows… What an Abortion Is Like”: A Qualitative Analysis of Medical Students’ Experiences With Second-Trimester Procedural Abortions","authors":"Kathryn Crofton MD, Rachel Flink-Bochacki MD, MPH, Brooke Zaiz MD, Johanna Bringley DO","doi":"10.1016/j.whi.2024.09.006","DOIUrl":"10.1016/j.whi.2024.09.006","url":null,"abstract":"<div><h3>Objectives</h3><div>Medical students value abortion education; however, there has been little study regarding participation in second-trimester procedures, which are less common yet receive significant societal attention. We aimed to explore medical students’ perceptions of participation in second-trimester procedural abortions to optimize this educational experience.</div></div><div><h3>Study Design</h3><div>We conducted qualitative semi-structured interviews with third- and fourth-year medical students who voluntarily participated in second-trimester dilation and evacuation cases. We coded interviews inductively and performed thematic content analysis until thematic saturation was reached.</div></div><div><h3>Participants</h3><div>We interviewed 25 medical students, including 16 third-year and nine fourth-year students. Most participants were female (64%) and white (58%) and had no prior abortion care experience (80%).</div></div><div><h3>Results</h3><div>Four major themes emerged: 1) students felt unprepared for second-trimester procedural abortions and were unable to find adequate educational resources for preparation; 2) students experienced complex emotional reactions to the procedures, often finding the experience more challenging than expected; 3) students observed implicit expectations and biases in the learning environment; and 4) students highly valued their involvement in abortion procedures, noting that participation was important for their future practice and allowed acquisition of essential clinical skills.</div></div><div><h3>Conclusions</h3><div>Medical students value the educational opportunity to participate in second-trimester procedural abortions; however, most feel unprepared for the technical and emotional aspects, despite utilizing available educational resources. To maximize educational experience and psychological safety, educators should develop specialized training resources. This could strengthen physician knowledge and comfort with abortion care in the future, ultimately improving patient care.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 1","pages":"Pages 14-19"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606944","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

“Just Google It”: A Qualitative Study of Reproductive-Age Women's Stigmatizing Experiences When Accessing Buprenorphine for Opioid Use Disorder "只需谷歌"--生殖年龄妇女在使用丁丙诺啡治疗阿片类药物使用障碍时的污名化经历定性研究。

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

Womens Health Issues

Pub Date : 2025-01-01 DOI: 10.1016/j.whi.2024.10.003

Dominique Bulgin PhD, RN , Velma McBride Murry PhD , Tamarra McElroy MPH , David Schlundt PhD , Kemberlee Bonnet MA , Stephen W. Patrick MD, MPH, MS

Introduction

The opioid crisis is increasingly impacting women, and access to buprenorphine to treat opioid use disorder (OUD) is limited by the number of providers authorized to dispense it. Stigma can represent an additional barrier to accessing medication for OUD. Qualitative data were analyzed from a randomized simulated patient field experiment of calls to outpatient buprenorphine-waivered providers.

Objectives

Our primary objective was to analyze descriptions of barriers women encountered when seeking buprenorphine to treat OUD to account for differential experiences based on pregnancy status, race/ethnicity, and insurance status. Our secondary objective was to identify potential intervention strategies to improve access to medications for OUD.

Methods

The Health Stigma and Discrimination framework was applied to guide our study of barriers encountered by women seeking OUD treatment. Callers representing vocal features of white, Hispanic, and Black women and simulating ages 25–30 were randomized to represent combinations of public/private insurance and pregnant/not pregnant characteristics. Callers contacted 5,944 buprenorphine-waivered providers requesting to make an appointment to obtain medications to treat OUD. There were 15,358 free-text comments in response to the prompt “Please give an objective play-by-play of the description of what happened in this conversation.” Data were coded and analyzed using an iterative inductive-deductive approach. We consulted six community experts, women who had sought treatment for OUD, to inform our study findings and identify patient-driven solutions to address barriers.

Results

Findings revealed that experiences of interpersonal stigma were connected to systemic barriers such as stigmatizing behaviors within institutional cultures and normative practices. Key results indicate that race/ethnicity, pregnancy status, and insurance status influence experiences of stigma. For instance, Black and Hispanic callers reported experiencing race-based microaggressions, and pregnant women faced additional judgment and reduced access to treatment. Qualitative findings and community experts’ insights underscored the necessity for the adoption of anti-stigma policies and practices that facilitate easier access to medications for OUD across socioecological levels.

Conclusions

The findings demonstrate a need for multilevel interventions to improve women's access to medications for OUD.

导言：阿片类药物危机对女性的影响越来越大，而获得丁丙诺啡治疗阿片类药物使用障碍（OUD）的机会受到了授权配药医疗机构数量的限制。污名化可能是获得治疗阿片类药物使用障碍药物的另一个障碍。我们对门诊丁丙诺啡提供者的随机模拟患者现场实验的定性数据进行了分析：我们的首要目标是分析妇女在寻求丁丙诺啡治疗 OUD 时遇到的障碍，以考虑到基于怀孕状况、种族/民族和保险状况的不同经历。我们的次要目标是确定潜在的干预策略，以改善获得治疗 OUD 药物的机会：我们采用了 "健康羞辱与歧视 "框架来指导我们对寻求 OUD 治疗的妇女所遇到的障碍进行研究。代表白人、西班牙裔和黑人女性声音特征、模拟 25-30 岁女性的呼叫者被随机分配，以代表公共/私人保险和怀孕/未怀孕特征的组合。来电者联系了 5,944 个提供丁丙诺啡的医疗机构，要求预约以获得治疗 OUD 的药物。有 15,358 条自由文本评论回复了 "请客观地逐一描述这次对话中发生的事情 "的提示。我们采用归纳-演绎迭代法对数据进行了编码和分析。我们咨询了六位社区专家，她们都是曾寻求过 OUD 治疗的女性，为我们的研究结果提供了参考，并找出了以患者为导向的解决方案来解决障碍：研究结果表明，人际间的污名化经历与制度性障碍有关，如制度文化和规范性实践中的污名化行为。主要结果表明，种族/民族、怀孕状况和保险状况会影响鄙视经历。例如，黑人和拉美裔来电者报告说，他们经历了基于种族的微词攻击，而孕妇则面临更多的评判，获得治疗的机会也减少了。定性研究结果和社区专家的见解强调，有必要采取反污名化政策和措施，以方便不同社会生态层面的人获得治疗 OUD 的药物：研究结果表明，有必要采取多层次干预措施，以改善妇女获得治疗 OUD 药物的机会。

{"title":"“Just Google It”: A Qualitative Study of Reproductive-Age Women's Stigmatizing Experiences When Accessing Buprenorphine for Opioid Use Disorder","authors":"Dominique Bulgin PhD, RN , Velma McBride Murry PhD , Tamarra McElroy MPH , David Schlundt PhD , Kemberlee Bonnet MA , Stephen W. Patrick MD, MPH, MS","doi":"10.1016/j.whi.2024.10.003","DOIUrl":"10.1016/j.whi.2024.10.003","url":null,"abstract":"<div><h3>Introduction</h3><div>The opioid crisis is increasingly impacting women, and access to buprenorphine to treat opioid use disorder (OUD) is limited by the number of providers authorized to dispense it. Stigma can represent an additional barrier to accessing medication for OUD. Qualitative data were analyzed from a randomized simulated patient field experiment of calls to outpatient buprenorphine-waivered providers.</div></div><div><h3>Objectives</h3><div>Our primary objective was to analyze descriptions of barriers women encountered when seeking buprenorphine to treat OUD to account for differential experiences based on pregnancy status, race/ethnicity, and insurance status. Our secondary objective was to identify potential intervention strategies to improve access to medications for OUD.</div></div><div><h3>Methods</h3><div>The Health Stigma and Discrimination framework was applied to guide our study of barriers encountered by women seeking OUD treatment. Callers representing vocal features of white, Hispanic, and Black women and simulating ages 25–30 were randomized to represent combinations of public/private insurance and pregnant/not pregnant characteristics. Callers contacted 5,944 buprenorphine-waivered providers requesting to make an appointment to obtain medications to treat OUD. There were 15,358 free-text comments in response to the prompt “Please give an objective play-by-play of the description of what happened in this conversation.” Data were coded and analyzed using an iterative inductive-deductive approach. We consulted six community experts, women who had sought treatment for OUD, to inform our study findings and identify patient-driven solutions to address barriers.</div></div><div><h3>Results</h3><div>Findings revealed that experiences of interpersonal stigma were connected to systemic barriers such as stigmatizing behaviors within institutional cultures and normative practices. Key results indicate that race/ethnicity, pregnancy status, and insurance status influence experiences of stigma. For instance, Black and Hispanic callers reported experiencing race-based microaggressions, and pregnant women faced additional judgment and reduced access to treatment. Qualitative findings and community experts’ insights underscored the necessity for the adoption of anti-stigma policies and practices that facilitate easier access to medications for OUD across socioecological levels.</div></div><div><h3>Conclusions</h3><div>The findings demonstrate a need for multilevel interventions to improve women's access to medications for OUD.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 1","pages":"Pages 45-53"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740958","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

Community-dwelling Black Women's Experiences With Urinary Incontinence: A Qualitative Study 社区黑人妇女的尿失禁经历：定性研究。

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

Womens Health Issues

Pub Date : 2025-01-01 DOI: 10.1016/j.whi.2024.10.002

Gnankang Sarah Napoé MD, MS , Courtney Judkins BA , Flor de Abril Cameron PhD, MPH , Megan E. Hamm PhD , Judy C. Chang MD, MPH , Pamela A. Moalli MD, PhD

Objectives

We explored Black women's experiences, concerns, decisions, and challenges of seeking care for urinary incontinence (UI).

Methods

After screening for UI, we collected questionnaires confirming UI bother. We performed semistructured, one-on-one interviews via video or phone with adult participants who self-identify as Black women and had symptoms of UI. We asked about experiences with UI, perceived impact on quality of life, care-seeking behaviors, and any challenges to seeking care. Audio recordings were transcribed and coded. We then explored the patterns and relationships between codes to identify categories and themes.

Results

We interviewed 24 Black women with UI, aged 19 to 73 years. All had some college education, and more than one-half had degrees ranging from associate to graduate. Five themes emerged: 1) UI symptoms bring up negative emotions and require adaptations; 2) normalization of UI decreases symptom reporting and care seeking; 3) participants' UI and other medical symptoms were often minimized or dismissed by clinicians; 4) participants desire routine UI screening by clinicians and enhanced UI education; and 5) participants encourage more diversity and higher quality care to improve patient trust.

Conclusions

In addition to embarrassment, Black women's challenges to seeking UI care include prior experiences of trauma within the health care system. Routine screening of patients, enhanced UI education, and provider trust building could improve Black women's experiences and willingness to seek UI care.

目的我们探讨了黑人妇女在寻求尿失禁（UI）治疗时的经历、担忧、决定和挑战：在进行尿失禁筛查后，我们收集了确认尿失禁困扰的问卷。我们通过视频或电话对自我认同为黑人女性且有尿失禁症状的成年参与者进行了半结构化的一对一访谈。我们询问了有关尿失禁的经历、对生活质量的影响、求医行为以及求医过程中遇到的任何困难。我们对录音进行了转录和编码。然后，我们探讨了编码之间的模式和关系，以确定类别和主题：我们采访了 24 名患有 UI 的黑人妇女，她们的年龄从 19 岁到 73 岁不等。所有人都受过一定的大学教育，超过一半的人拥有从副学士学位到研究生学位不等的学历。我们发现了五个主题：1）尿崩症症状会带来负面情绪，需要适应；2）尿崩症的正常化会减少症状报告和寻求护理的次数；3）参与者的尿崩症和其他医学症状经常被临床医生最小化或忽略；4）参与者希望临床医生进行常规尿崩症筛查并加强尿崩症教育；5）参与者鼓励更多的多样性和更高质量的护理，以提高患者的信任度：除了尴尬之外，黑人妇女在寻求尿失禁治疗时面临的挑战还包括之前在医疗系统中的创伤经历。对患者进行常规筛查、加强 UI 教育以及建立对医疗服务提供者的信任可以改善黑人妇女的 UI 就医经历和意愿。

{"title":"Community-dwelling Black Women's Experiences With Urinary Incontinence: A Qualitative Study","authors":"Gnankang Sarah Napoé MD, MS , Courtney Judkins BA , Flor de Abril Cameron PhD, MPH , Megan E. Hamm PhD , Judy C. Chang MD, MPH , Pamela A. Moalli MD, PhD","doi":"10.1016/j.whi.2024.10.002","DOIUrl":"10.1016/j.whi.2024.10.002","url":null,"abstract":"<div><h3>Objectives</h3><div>We explored Black women's experiences, concerns, decisions, and challenges of seeking care for urinary incontinence (UI).</div></div><div><h3>Methods</h3><div>After screening for UI, we collected questionnaires confirming UI bother. We performed semistructured, one-on-one interviews via video or phone with adult participants who self-identify as Black women and had symptoms of UI. We asked about experiences with UI, perceived impact on quality of life, care-seeking behaviors, and any challenges to seeking care. Audio recordings were transcribed and coded. We then explored the patterns and relationships between codes to identify categories and themes.</div></div><div><h3>Results</h3><div>We interviewed 24 Black women with UI, aged 19 to 73 years. All had some college education, and more than one-half had degrees ranging from associate to graduate. Five themes emerged: 1) UI symptoms bring up negative emotions and require adaptations; 2) normalization of UI decreases symptom reporting and care seeking; 3) participants' UI and other medical symptoms were often minimized or dismissed by clinicians; 4) participants desire routine UI screening by clinicians and enhanced UI education; and 5) participants encourage more diversity and higher quality care to improve patient trust.</div></div><div><h3>Conclusions</h3><div>In addition to embarrassment, Black women's challenges to seeking UI care include prior experiences of trauma within the health care system. Routine screening of patients, enhanced UI education, and provider trust building could improve Black women's experiences and willingness to seek UI care.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 1","pages":"Pages 39-44"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677269","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