Center for Public Health Practice and Research, Population Health Sciences, Virginia Tech, Blacksburg, VA 24061, USA
Workforce, DeBeaumont Foundation, 7501 Wisconsin Avenue, Bethesda, MD 20814, USA
Rural Remote Health. 2021 May;21(2):6308. doi: 10.22605/RRH6308. Epub 2021 May 9.
In the USA, approximately 45% of pregnancies are unintended. Accessing quality contraceptives can be a barrier for some individuals, especially low-income, uninsured, minority or younger women. These problems are exacerbated in rural areas{1}. Integrating contraceptive services into primary care is an approach to ensure that sexually active women receive access to contraceptives. This study documented how one rural Federally Qualified Health Center (FQHC) adapted to their culturally conservative environment by offering contraceptive counseling, comprehensive education on birth control, and access to contraceptive services directly through primary care.
Twenty-one semi structured interviews were conducted and analyzed in Atlas.ti®. All women patients who had received contraceptive services through primary care in the previous 6 months were invited to participate in a semi-structured interview. A sample of current and past board members were invited to participate in semi-structured interviews. A sample of five primary care providers and nurses who interact with women receiving contraceptive services was invited to participate in a semi-structured, in-person interview. In addition, the executive director, the clinic manager, and the current and past medical directors were interviewed. A hybrid of inductive and deductive coding methods was used for theme generation.
Interviews helped to highlight some of the barriers to accessing contraceptives currently experienced by women in this rural area, and showcased how this FQHC is adapting their approach and their services to be able to meet patient needs. The following themes emerged: lack of knowledge about services offered, lack of knowledge about birth control, misinformation and misconceptions, education on birth control, and care model.
The cultural context of Southwest Virginia, including the cultural conservatism and stigma associated with talking about sex, has a big impact on people's willingness to access contraceptive services. Stigma limits educational opportunities being offered in schools, therefore limiting people's knowledge about services and birth control methods. This FQHC has adapted to their surrounding culture by ensuring that every woman seeking primary care at the FQHC is screened for contraceptive need, offered contraceptive counseling and comprehensive contraceptive methods. This FQHC's integration of contraceptive services is a model that can be replicated by other FQHCs, by local health departments, and by private physicians.
在美国，约有 45%的妊娠是意外的。对于一些人来说，获得高质量的避孕措施可能是一个障碍，尤其是低收入、没有保险、少数族裔或年轻女性。这些问题在农村地区更加严重{1}。将避孕服务整合到初级保健中是确保有性行为的女性获得避孕措施的一种方法。本研究记录了一家农村合格的联邦健康中心（FQHC）如何通过提供避孕咨询、全面的节育教育以及直接通过初级保健获得避孕服务，来适应其文化保守环境。
对 21 次半结构访谈进行了分析，并使用 Atlas.ti®进行了分析。所有在过去 6 个月内通过初级保健获得避孕服务的女性患者都被邀请参加半结构访谈。邀请现任和前任董事会成员参加半结构访谈。邀请五名与接受避孕服务的女性互动的初级保健提供者和护士参加半结构的现场访谈。此外，还采访了执行主任、诊所经理以及现任和前任医疗主任。使用归纳和演绎编码方法的混合方法生成主题。
访谈有助于突出当前该农村地区女性在获得避孕措施方面面临的一些障碍，并展示了这家 FQHC 如何调整其方法和服务，以满足患者的需求。出现了以下主题：对所提供服务的了解不足、对节育的了解不足、错误信息和误解、节育教育以及护理模式。
弗吉尼亚州西南部的文化背景，包括与谈论性相关的文化保守主义和耻辱感，对人们接受避孕服务的意愿有很大影响。耻辱感限制了学校提供的教育机会，因此限制了人们对服务和避孕方法的了解。这家 FQHC 已经适应了周围的文化，确保每个在 FQHC 寻求初级保健的女性都接受避孕需求筛查，提供避孕咨询和全面的避孕方法。这家 FQHC 将避孕服务整合在一起，是其他 FQHC、地方卫生部门和私人医生可以复制的模式。
