Gilmore Kelly, Hoopes Andrea J, Cady Janet, Amies Oelschlager Anne-Marie, Prager Sarah, Vander Stoep Ann
Department of Health Services, School of Public Health, University of Washington, Seattle, Washington.
Department of Health Services, School of Public Health, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington.
J Adolesc Health. 2015 Jun;56(6):658-65. doi: 10.1016/j.jadohealth.2015.02.016.
PURPOSE: The purpose of this study was to describe the implementation of a program that provides long-acting reversible contraception (LARC) services within school-based health centers (SBHCs) and to identify barriers and facilitators to implementation as reported by SBHC clinicians and administrators, public health officials, and community partners. METHODS: We conducted 14 semistructured interviews with key informants involved in the implementation of LARC services. Key informants included SBHC clinicians and administrators, public health officials, and community partners. We used a content analysis approach to analyze interview transcripts for themes. We explored barriers to and facilitators of LARC service delivery across and within key informant groups. RESULTS: The most cited barriers across key informant groups were as follows: perceived lack of provider procedural skills and bias and negative attitudes about LARC methods. The most common facilitators identified across groups were as follows: clear communication strategies, contraceptive counseling practice changes, provider trainings, and stakeholder engagement. Two additional barriers emerged in specific key informant groups. Technical and logistical barriers to LARC service delivery were cited heavily by SBHC administrative staff, community partners, and public health officials. Expense and billing was a major barrier to SBHC administrative staff. CONCLUSIONS: LARC counseling and procedural services can be implemented in an SBHC setting to promote access to effective contraceptive options for adolescent women.
目的:本研究的目的是描述一项在学校健康中心(SBHCs)提供长效可逆避孕(LARC)服务的项目的实施情况,并确定SBHC临床医生和管理人员、公共卫生官员以及社区合作伙伴报告的实施障碍和促进因素。 方法:我们对参与LARC服务实施的关键信息提供者进行了14次半结构化访谈。关键信息提供者包括SBHC临床医生和管理人员、公共卫生官员以及社区合作伙伴。我们采用内容分析方法来分析访谈记录中的主题。我们探讨了关键信息提供者群体之间以及群体内部LARC服务提供的障碍和促进因素。 结果:关键信息提供者群体中最常被提及的障碍如下:认为提供者缺乏操作技能,以及对LARC方法存在偏见和消极态度。各群体中确定的最常见促进因素如下:明确的沟通策略、避孕咨询实践的改变、提供者培训以及利益相关者的参与。在特定的关键信息提供者群体中还出现了另外两个障碍。SBHC行政人员、社区合作伙伴和公共卫生官员大量提及了LARC服务提供的技术和后勤障碍。费用和计费是SBHC行政人员面临的主要障碍。 结论:LARC咨询和程序服务可以在SBHC环境中实施,以促进青少年女性获得有效的避孕选择。
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