Politi Mary C, Estlund Amy, Milne Anne, Buckel Christina M, Peipert Jeffrey F, Madden Tessa
Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 S Euclid Ave, CB 8100, St Louis, MO 63110 USA.
Divisions of Family Planning and Clinical Research, Department of Obstetrics & Gynecology, Washington University in St. Louis School of Medicine, 4533 Clayton Ave, Box 8019, St. Louis, USA.
Contracept Reprod Med. 2016 Nov 8;1:21. doi: 10.1186/s40834-016-0032-3. eCollection 2016.
The Contraceptive CHOICE Project developed a patient-centered model for contraceptive provision including: (1) structured, evidence-based counseling; (2) staff and health care provider education; and (3) removal of barriers such as cost and multiple appointments to initiate contraception. In preparation for conducting a research study of the CHOICE model in three community health settings, we sought to identify potential barriers and facilitators to implementation.
Using a semi-structured interview guide guided by a framework of implementation research, we conducted 31 qualitative interviews with female patients, staff, and health care providers assessing attitudes, beliefs, and barriers to receiving contraception. We also asked about current contraceptive provision and explored organizational practices relevant to implementing the CHOICE model. We used a grounded theory approach to identify major themes.
Many participants felt that current contraceptive provision could be improved by the CHOICE model. Potential facilitators included agreement about the necessity for improved contraceptive knowledge among patients and staff; importance of patient-centered contraceptive counseling; and benefits to same-day insertion of long-acting reversible contraception (LARC). Potential barriers included misconceptions about contraception held by staff and providers; resistance to new practices; costs associated with LARC; and scheduling challenges required for same-day insertion of LARC.
In addition to staff and provider training, implementing a patient-centered model of contraceptive provision needs to be supplemented by strategies to manage patient and system-level barriers. Community health center staff, providers, and patients support patient-centered contraceptive counseling to improve contraception provision if organizations can address these barriers.
避孕选择项目开发了一种以患者为中心的避孕服务模式，包括：（1）结构化的、基于证据的咨询；（2）工作人员和医疗服务提供者教育；以及（3）消除诸如费用和多次预约等启动避孕措施的障碍。在准备对三个社区卫生机构的选择模式进行研究时，我们试图确定实施的潜在障碍和促进因素。
我们使用由实施研究框架指导的半结构化访谈指南，对女性患者、工作人员和医疗服务提供者进行了31次定性访谈，评估接受避孕措施的态度、信念和障碍。我们还询问了当前的避孕服务情况，并探讨了与实施选择模式相关的组织实践。我们采用扎根理论方法来确定主要主题。
许多参与者认为，选择模式可以改善当前的避孕服务。潜在的促进因素包括患者和工作人员对提高避孕知识必要性的认同；以患者为中心的避孕咨询的重要性；以及长效可逆避孕法（LARC）当日植入的益处。潜在障碍包括工作人员和提供者对避孕的误解；对新实践的抵触；与LARC相关的费用；以及LARC当日植入所需的日程安排挑战。
除了工作人员和提供者培训外，实施以患者为中心的避孕服务模式还需要通过管理患者和系统层面障碍的策略来加以补充。如果组织能够解决这些障碍，社区卫生中心的工作人员、提供者和患者支持以患者为中心的避孕咨询，以改善避孕服务。
