Hill Amber L, Zachor Hadas, Miller Elizabeth, Talis Janine, Zelazny Sarah, Jones Kelley A
Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Department of Psychiatry and Behavioral Science, Johns Hopkins Medicine, Baltimore, Maryland, USA.
J Womens Health (Larchmt). 2021 Apr;30(4):604-614. doi: 10.1089/jwh.2020.8527. Epub 2020 Nov 18.
Intimate partner violence (IPV) and reproductive coercion impact women seeking care at family planning (FP) clinics. Interventions to facilitate patient-provider conversations about healthy relationships are needed. We sought to determine the added effect of providing psychoeducational messages to patients compared with tailored provider scripts alone on sexual and reproductive health outcomes at 4-6 months. We randomized participants to Trauma-Informed Personalized Scripts (TIPS)-Plus (provider scripts +patient messages) or TIPS-Basic (provider scripts only) at four FP clinics. Eligible patients included English-speaking females aged 16-29 years. Data were collected at initial visits (T1) and 4-6 months (T2) on IPV, reproductive coercion, fear, condom and other contraceptive use, self-efficacy, harm reduction behaviors, and knowledge/use of IPV-related services. We compared frequencies and summary scores between baseline and follow-up with McNemar's test of paired proportions and Signed Rank-Sum, respectively. We compared the difference in differences over time by treatment arm using two-sample -tests, and used linear, logistic, and ordinal logistic regression to compare intervention effects at follow-up. Two hundred forty patients participated (114 TIPS-Plus, 126 TIPS-Basic), 216 completed follow-up. We detected no differences in outcomes between treatment arms. Between T1 and T2, we observed overall reductions in mean summary scores for reproductive coercion (T1 = 0.08 ± 0.02, T2 = 0.02 ± 0.01, = 0.028) and increases in contraceptive use (69.6%-87.9%, < 0.001), long-acting reversible contraceptives (8.3%-20.8%, < 0.001), and hidden methods (20%-38.5%, < 0.001). We show no added benefit of patient-activation messages compared with provider scripts alone. Findings suggest potential utility of provider scripts in addressing reproductive coercion and contraceptive uptake (Trial Registration No. NCT02782728).
亲密伴侣暴力（IPV）和生殖胁迫会影响到在计划生育（FP）诊所寻求护理的女性。需要采取干预措施，以促进医患之间就健康关系进行对话。我们试图确定，与仅提供量身定制的医生脚本相比，向患者提供心理教育信息对4至6个月时的性健康和生殖健康结果的额外影响。我们在四家计划生育诊所将参与者随机分为创伤知情个性化脚本增强版（TIPS-Plus，医生脚本+患者信息）或创伤知情个性化脚本基础版（TIPS-Basic，仅医生脚本）。符合条件的患者包括年龄在16至29岁之间、说英语的女性。在初次就诊时（T1）以及4至6个月时（T2）收集有关亲密伴侣暴力、生殖胁迫、恐惧、避孕套及其他避孕措施的使用、自我效能、减少伤害行为以及亲密伴侣暴力相关服务的知晓/使用情况的数据。我们分别使用配对比例的McNemar检验和符号秩和检验来比较基线和随访之间的频率及汇总分数。我们使用双样本t检验比较不同治疗组随时间变化的差异，并使用线性、逻辑和有序逻辑回归来比较随访时的干预效果。240名患者参与研究（114名TIPS-Plus组，126名TIPS-Basic组），216名完成随访。我们未发现不同治疗组之间在结果上存在差异。在T1和T2之间，我们观察到生殖胁迫的平均汇总分数总体下降（T1 = 0.08±0.02，T2 = 0.02±0.01，P = 0.028），避孕措施的使用增加（69.6%-87.9%，P<0.001），长效可逆避孕措施的使用增加（8.3%-20.8%，P<0.001），以及隐蔽避孕方法的使用增加（20%-38.5%，P<0.001）。我们发现，与仅提供医生脚本相比，患者激活信息并无额外益处。研究结果表明医生脚本在解决生殖胁迫和避孕措施采用方面具有潜在效用（试验注册号：NCT02782728）。
