Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Department of Political Science, Clemson University, Clemson, South Carolina.
Womens Health Issues. 2022 Mar-Apr;32(2):165-172. doi: 10.1016/j.whi.2021.11.010. Epub 2021 Dec 17.
Previous studies conducted from the patient perspective indicate that women with substance use disorders (SUDs) experience extensive barriers to contraceptive access and use (CAU), but there is limited research investigating this topic from the provider perspective. We explored provider perspectives on the barriers to CAU for women with SUDs. As a secondary objective, we highlighted provider contraceptive counseling strategies to address patient CAU barriers.
We conducted 24 qualitative interviews with a purposeful sample of women's health providers, including medical doctors, nurse practitioners, and certified nurse-midwives. We used thematic analysis to code the interviews with inductive codes and organized findings according to levels of influence within the Dahlgren and Whitehead rainbow model, a socioecological model of health.
Provider-reported barriers to CAU were identified at four levels of socioecological influence and included reproductive misconceptions; active substance use; trauma, interpersonal violence, and reproductive coercion; limited social support; lack of housing, employment, health insurance, and transportation; stigma; discrimination; and punitive prenatal substance use policies and child welfare reporting requirements. Strategies for addressing CAU barriers mainly focused on patient-centered communication, including open information exchange, shared decision-making, and relationship building. However, providers described disproportionately highlighting the benefits of long-acting reversible contraception (LARC) and directing conversations toward LARC when they perceived that such methods would help patients to overcome adherence and other challenges related to active substance use or logistical barriers. Notably, there was no mention of CAU facilitators during the interviews.
Providers perceived that women with SUDs experience a range of CAU barriers, which they addressed within the clinical setting through use of both patient-centered communication and highlighting the benefits of LARC when they perceived that such methods would help clients to overcome barriers. Improving CAU for women with SUDs will require multidisciplinary, multipronged strategies that prioritize reproductive autonomy and are implemented across clinical, community, and policy settings.
之前从患者角度进行的研究表明，患有物质使用障碍（SUD）的女性在获得和使用避孕措施（CAU）方面面临着诸多障碍，但从提供者角度调查这一主题的研究有限。我们探讨了提供者对 SUD 女性 CAU 障碍的看法。作为次要目标，我们强调了提供者解决患者 CAU 障碍的避孕咨询策略。
我们对包括医生、执业护士和认证助产士在内的女性健康提供者进行了 24 次有针对性的定性访谈。我们使用主题分析方法对访谈进行了编码，使用归纳代码，并根据达尔格伦和怀特黑德彩虹模型（一种健康的社会生态学模型）的影响层次组织了研究结果。
提供者报告的 CAU 障碍在社会生态学影响的四个层次上被确定，包括生殖误解；积极的物质使用；创伤、人际暴力和生殖胁迫；有限的社会支持；缺乏住房、就业、健康保险和交通；耻辱感；歧视；以及惩罚性的产前物质使用政策和儿童福利报告要求。解决 CAU 障碍的策略主要侧重于以患者为中心的沟通，包括开放的信息交流、共同决策和关系建立。然而，提供者描述了不成比例地强调长效可逆避孕（LARC）的好处，并在他们认为这些方法有助于患者克服与积极物质使用或后勤障碍相关的坚持和其他挑战时，将对话引导到 LARC 上。值得注意的是，在访谈中没有提到 CAU 的促进因素。
提供者认为患有 SUD 的女性在获得和使用避孕措施方面面临着一系列障碍，他们在临床环境中通过使用以患者为中心的沟通以及强调 LARC 的好处来解决这些障碍，当他们认为这些方法有助于患者克服障碍时。改善患有 SUD 的女性的 CAU 需要多学科、多管齐下的策略，优先考虑生殖自主权，并在临床、社区和政策环境中实施。
