Katz-Wise Sabra L, Gordon Allegra R, Burke Pamela J, Jonestrask Cassandra, Shrier Lydia A
Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA.
Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA.
J Pediatr Adolesc Gynecol. 2020 Aug;33(4):363-371. doi: 10.1016/j.jpag.2020.02.012. Epub 2020 Mar 5.
This study identified clinician and clinic staff perspectives on facilitators and barriers to providing sexual and reproductive health (SRH) care to depressed young women, a population at increased risk for adverse SRH outcomes.
We conducted in-person semi-structured qualitative interviews, which were audio-recorded, transcribed, and coded by two researchers. We used thematic analysis to identify themes pertaining to care facilitators and barriers within a socio-ecological framework.
This study was conducted in seven diverse clinics in the U.S. New England region.
Participants were 28 clinicians and staff (4/clinic), including behavioral health clinicians (n = 9), nurse practitioners (n = 7), nurses (n = 3), medical doctors (n = 3), administrative associates (n = 2), practice managers (n = 2), family planning counselor (n = 1), and medical assistant (n = 1).
We queried how clinicians and clinic staff identify and manage depression and sexual risk, and what they perceive as facilitators and barriers affecting provision of ideal SRH care to depressed young women.
Themes represented facilitators of and barriers to providing ideal SRH care to high-risk depressed young women at five socio-ecological levels: individual (facilitator: trust in providers; barrier: stigma experiences), interpersonal/provider (facilitator: frequent patient-provider communication; barrier: lack of time during clinic visits to build trust), clinic (facilitator: integration of care; barrier: lack of scheduling flexibility), organization/community (facilitator: training for providers; barrier: funding constraints), and macro/societal (facilitator: supportive policies; barrier: mental health stigma).
Optimizing SRH care to high-risk depressed young women necessitates attention to factors on all socio-ecological levels to remove barriers and bolster existing facilitators of care.
本研究确定了临床医生和诊所工作人员对于向抑郁年轻女性提供性与生殖健康（SRH）护理的促进因素和障碍的看法，这一群体出现不良SRH结局的风险增加。
我们进行了面对面的半结构化定性访谈，由两名研究人员进行录音、转录和编码。我们使用主题分析来确定社会生态框架内与护理促进因素和障碍相关的主题。
本研究在美国新英格兰地区的七家不同诊所进行。
参与者为28名临床医生和工作人员（每家诊所4名），包括行为健康临床医生（n = 9）、执业护士（n = 7）、护士（n = 3）、医生（n = 3）、行政助理（n = 2）、业务经理（n = 2）、计划生育顾问（n = 1）和医疗助理（n = 1）。
我们询问了临床医生和诊所工作人员如何识别和管理抑郁及性风险，以及他们认为影响为抑郁年轻女性提供理想SRH护理的促进因素和障碍是什么。
主题代表了在五个社会生态层面为高风险抑郁年轻女性提供理想SRH护理的促进因素和障碍：个体层面（促进因素：对提供者的信任；障碍：耻辱经历）、人际/提供者层面（促进因素：患者与提供者的频繁沟通；障碍：门诊就诊时缺乏建立信任的时间）、诊所层面（促进因素：护理整合；障碍：缺乏排班灵活性）、组织/社区层面（促进因素：为提供者提供培训；障碍：资金限制）和宏观/社会层面（促进因素：支持性政策；障碍：心理健康耻辱）。
优化对高风险抑郁年轻女性的SRH护理需要关注所有社会生态层面的因素，以消除障碍并加强现有的护理促进因素。
