University of Colorado, Aurora, CO, United States.
University of Colorado, Aurora, CO, United States.
Contraception. 2021 Oct;104(4):406-413. doi: 10.1016/j.contraception.2021.07.003. Epub 2021 Jul 14.
The objective of this analysis was to present our secondary outcomes (reach, adoption, implementation, maintenance domains) of a prospective trial to test the efficacy of a home-based intervention to increase postpartum contraceptive uptake.
We executed a cluster-randomized trial to determine if provision of contraception in the home setting increased uptake of postpartum methods. We collected secondary outcomes on how our implementation strategies of revising professional roles and changing service sites performed in terms of the number of people our study enrolled of all women eligible (reach), how it was accepted by the providers (adoption), what methods were used to conduct the study (implementation), and preliminary results on whether or not the intervention will be continued (maintenance). We conducted a survey and focus group discussion to assess adoption and implementation among intervention nurse staff, and a survey in a convenience sample of patients in the intervention arm to assess acceptability.
Our primary outcome of effectiveness has been published; implant uptake was 25% in the intervention cohort compared to 3% in the control clusters. Our reach was 89%, as 208 of the 234 eligible women consented to participate. Among a convenience sample of N = 25 patients completing a survey on the intervention 12 months after enrollment, ≥ 68% (n = 17 of 25) felt the intervention was acceptable. From the nursing perspective (N = 7), only a minority of nurses felt the intervention was complicated (n = 1, 17%), and (n = 7, 100%) reported the intervention was acceptable.
Our intervention achieved good reach (89% of the eligible population) and was acceptable to the majority of patients and providers. Practitioners interested in achieving greater reach of contraceptive interventions in their communities may consider changing service sites to convenience their clients, as our results suggest this approach was acceptable.
The unique contribution of this paper is in its success with training nurses to insert contraceptive implants during postpartum home visits, which resulted in increased uptake of the contraceptive implant where access to the device was previously limited. Given the trial's successful feasibility and acceptability to both nurses and patients, perhaps this intervention has the potential to be adapted and scaled to other settings.
本分析的目的是呈现我们的次要结果（可及性、采用度、实施度、维持度领域），这是一项前瞻性试验的结果，旨在测试家庭为基础的干预措施增加产后避孕措施使用率的效果。
我们进行了一项群组随机试验，以确定在家庭环境中提供避孕措施是否会增加产后方法的使用率。我们收集了关于我们修改专业角色和改变服务地点的实施策略在我们研究招募的所有符合条件的女性（可及性）中的人数、提供者的接受程度（采用度）、用于进行研究的方法（实施度）以及干预是否会继续（维持度）方面的次要结果。我们对干预组的护士进行了调查和焦点小组讨论，以评估采用度和实施度，对干预组的便利样本患者进行了调查，以评估可接受度。
我们的有效性主要结果已经发表；在干预组中，植入物的使用率为 25%，而对照组的使用率为 3%。我们的可及性为 89%，因为 234 名符合条件的女性中有 208 名同意参与。在一项便利样本的 25 名患者中，他们在入组 12 个月后完成了一项关于干预措施的调查，≥68%（n=17/25）认为干预措施是可接受的。从护理角度来看（n=7），只有少数护士认为干预措施很复杂（n=1，17%），并且（n=7，100%）认为干预措施是可接受的。
我们的干预措施达到了很好的可及性（符合条件的人群的 89%），并得到了大多数患者和提供者的认可。对在其社区中实现更大避孕干预可及性感兴趣的从业者可能会考虑改变服务地点，以方便他们的客户，因为我们的结果表明这种方法是可以接受的。
本文的独特贡献在于成功培训护士在产后家访中插入避孕植入物，这导致在以前设备获取有限的情况下，避孕植入物的使用率增加。鉴于该试验在护士和患者方面的可行性和可接受性都取得了成功，也许这种干预措施有可能被改编并推广到其他环境中。
