Developing Evidence-Based Tools and Resources for Supporting Quality Family Planning Services in California
Reproductive health services, particularly family planning, provide mechanisms to avoid unintentional births. Unintentional births are oftentimes accompanied by adverse social, economic, and health outcomes for both child and mother.1 In 2011, less than half of pregnancies (45%) were unintended, as compared to 51% in 2008. The rates of unintended pregnancies were higher among low income, minority women. The availability of quality family planning services enables individuals to achieve their desired birth spacing and family size, and contributes to improved health outcomes for infants, children, women, and families.2
Located within the Department of Family and Community Medicine at the University of California, San Francisco, the Program in Woman-Centered Contraception (PWCC) is dedicated to the idea that women should be at the heart of all family efforts. By centering family planning research and practice on women’s needs, women will be more able to engage in care and to receive the family planning services they need. To accomplish this goal, PWCC engages in activities designed to develop, evaluate, and disseminate innovative family planning interventions, as well as conduct formative research to deepen an understanding of women’s preferences and experiences around contraception.3 With a focus on low-income, diverse populations and client-centered counseling, PWCC conducts research investigating provider-patient interactions in family planning settings, women’s social communication around birth-control methods, contraceptive decision making, and family-planning disparities.
The work of PWCC is aligned with evidence-based recommendations for providing quality family planning services (known as QFP) published by the Centers for Disease Control and Prevention and the Office of Population Affairs (OPA) in 2014.4 These recommendations focus on the importance of providing contraceptive and other care in a client-centered manner, including being respectful of, and responsive to, individual client preferences, needs, and values, and ensuring that client values guide all clinical decisions. A study conducted by PWCC supporting these recommendations found that contraceptive continuation and use of highly or moderately effective contraceptive methods are associated with patient-centered communication during contraceptive counseling.5
PWCC receives support to develop and implement family planning projects from various funders, including OPA and the Office of Adolescent Health (OAH). In 2016, PWCC began a 3-year project in collaboration with OPA that focused on client-centered contraceptive counseling. This project, entitled “Putting the focus on women’s contraceptive counseling experiences: The evaluation of a client-centered performance measure for contraceptive services,” was initiated in order to refine and test a Patient-Report Outcome Measure and a Patient-Reported Outcome Performance Measure that explicitly documents client-centered contraceptive counseling. This project has the ultimate goal of informing improvements to evidence-based, client-centered contraceptive counseling practices.3
Furthermore, in 2016, PWCC worked with OPA to adapt and disseminate QFP recommendations for use in the context of the Zika virus.6 Client-centered care is always important, but is particularly important in an emergency context. The toolkit addresses the client-centered counseling process that providers of contraceptive and other family planning services should understand and utilize to mitigate the impact of Zika. The toolkit also includes basic information on Zika, client handouts, and community outreach materials about the virus, as well as counseling considerations for practitioners.
In 2015, PWCC received funding from OAH via a 5-year cooperative agreement to develop, disseminate, and evaluate a social communication intervention on intrauterine devices (IUDs) and subdermal contraceptive implants for individuals aged 15–19 years.7 Previous research conducted by PWCC found that teenagers were less likely to know about, and more likely to have misinformation about, these highly effective methods than were older women. In order to address this lack of knowledge, this intervention, entitled “SpeakOut,” encourages adolescent users of these methods to share their experiences with IUDs and contraceptive implants with peers, thereby harnessing the power of social networks to disseminate evidence-based contraceptive information among adolescents. SpeakOut consists of a clinic session, pamphlets, text messages, and a website featuring video interviews with young IUD and implant users, and is available in both English and Spanish. Formative work leading to this intervention, which included interviews and focus groups with female adolescents, identified that adolescents value learning about contraceptive information from peers and have positive feelings about sharing their personal experiences. This year, PWCC is launching a randomized trial in several areas in California to evaluate the impact of the intervention on adolescents’ attitudes and practices with regard to IUDs and implants.
PWCC is continuing to develop and disseminate interventions, such as the MyBirthControl tablet-based decision support tool, which helps women select a contraceptive method that best fits their preferences, and uses evidence for women’s preferences for contraceptive counseling and evidence-based strategies for providing decision support in the clinical context. This type of intervention complements work done by OPA to increase access to care through their “Find a Planning Clinic” locator, which helps individuals to locate family planning clinics near them. Connecting women to services and ensuring that these services are client centered has the potential to improve women’s ability to achieve their reproductive goals and to reduce disparities among underserved populations.
4 Gavin L, Moskosky S, Carter M, Curtis K, Glass E, Godfrey E, et al. Providing quality family planning services: Recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recomm Rep. 2014;63(RR-04):1–29.
5 Dehlendorf C, Henderson JT, Vittinghoff E, Grumbach K, Levy K, Schmittdiel J, et al. Association of the quality of interpersonal care during family planning counseling with contraceptive use. Am J Obstet Gynecol. 2016;215(1):78. e1–9.
Person-Centered Reproductive Health Program
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