University of Maryland - School of Public Health, College Park, MD, USA.
Contraception. 2021 Aug;104(2):211-215. doi: 10.1016/j.contraception.2021.03.015. Epub 2021 Mar 21.
In 2014, Delaware launched a statewide initiative to reduce the rate of unintended pregnancies and increase access to contraception services. Our study objective was to understand the implementation experiences, barriers, and successes across health care practice settings and to provide recommendations for future, similar initiatives.
As part of a larger multicomponent process evaluation, we conducted semistructured interviews with 32 leaders from 26 practice settings implementing the initiative across the state. We analyzed the qualitative data through iterative open, axial, and selective coding using grounded theory methods, employing thematic analysis to identify common themes in implementation experiences.
Most practices perceived that patient demand for methods of long-acting reversible contraception (LARC) increased. Many practices had to adapt the intervention to fit the needs and constraints of their settings and patient populations. Primary care practices, smaller practices, and practices that served large numbers of adolescents experienced more barriers compared to obstetrics and gynecology or women's health practices. For current and future iterations of the initiative, leaders emphasized: (1) the need for greater implementation flexibility, (2) the importance of inclusive communication at multiple levels, and (3) attending to logistical challenges, particularly around billing.
Varied practice settings required significant flexibility and responsiveness to context in order to implement the initiative. Organizations with greater pre-existing capacity were able to offer the full range of contraceptive care, as the initiative intended, in contrast to practices with less pre-existing capacity for providing methods of LARC and other types of contraception.
To meet the specific but heterogenous needs of various practices, it is crucial for future contraceptive access initiatives to conduct a comprehensive pre-implementation assessment. Preceding any training, this assessment should gather input from participants across all roles in a medical practice (e.g., providers, medical assistants, office staff, billing department).
2014 年，特拉华州发起了一项全州范围的倡议，旨在降低意外怀孕率并增加避孕服务的可及性。我们的研究目的是了解医疗保健实践环境中的实施经验、障碍和成功因素，并为未来类似的倡议提供建议。
作为一项更大的多组分过程评估的一部分，我们对全州 26 个实施该倡议的实践环境中的 32 名领导者进行了半结构化访谈。我们使用扎根理论方法，通过迭代的开放式、轴向式和选择性编码对定性数据进行分析，采用主题分析来识别实施经验中的共同主题。
大多数实践认为患者对长效可逆避孕方法（LARC）的需求增加了。许多实践不得不调整干预措施，以适应其环境和患者群体的需求和限制。与妇产科或妇女健康实践相比，初级保健实践、较小的实践以及为大量青少年服务的实践遇到了更多的障碍。对于该倡议的当前和未来迭代，领导者强调：（1）需要更大的实施灵活性，（2）在多个层面上进行包容性沟通的重要性，以及（3）关注后勤方面的挑战，特别是计费方面。
不同的实践环境需要高度的灵活性和对环境的响应能力，才能实施该倡议。与提供 LARC 和其他类型避孕方法的能力较低的实践相比，具有更大的预先存在能力的组织能够按照倡议的初衷提供全面的避孕护理。
为了满足各种实践的具体但异质的需求，未来的避孕机会倡议必须进行全面的实施前评估。在进行任何培训之前，该评估应从医疗实践中的所有角色（例如，提供者、医疗助理、办公室工作人员、计费部门）收集参与者的意见。
