Hale Nathan, Dehlendorf Christine, Smith Michael G, Stapleton Jerod, McCartt Paezha, Khoury Amal J
Center for Applied Research and Evaluation in Women's Health and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, United States.
Person-Centered Reproductive Health Program, Department of Family and Community Medicine, University of California, San Francisco, CA, United States.
Contraception. 2024 Apr;132:110365. doi: 10.1016/j.contraception.2024.110365. Epub 2024 Jan 11.
We used the validated Person-Centered Contraceptive Counseling (PCCC) scale to examine experiences with counseling and associations between counseling quality, method satisfaction, and planned method continuation at the population level in two southeastern states.
We used data from the Statewide Survey of Women, a probability-based sample of reproductive-aged women in Alabama and South Carolina in 2017/18. We included women using a contraceptive method and reporting a contraceptive visit in the past year (n = 1265). Respondents rated their most recent provider experience across four PCCC items. Regression analyses examined relationships between counseling quality and outcomes of interest, and path analysis examined the extent to which method satisfaction mediated the effects of counseling quality on planned continuation.
Over half of participants (54%) reported optimal contraceptive counseling. Optimal counseling was associated with method satisfaction (aPR = 1.16; 95% confidence interval (CI) = 1.04-1.29) in adjusted models. Optimal counseling was marginally associated with planned discontinuation in the bivariate analysis but was attenuated in the adjusted model (aPR = 1.07; 95% CI = 0.98-1.18). In the path analysis, counseling quality influenced method satisfaction (0.143 (0.045), p = 0.001) which influenced planned continuation, controlling for PCCC (0.74 (0.07), p < 0.001). The total indirect effect of counseling quality on planned continuation was significant (0.106 (0.03), p = 0.001), and a residual direct effect from counseling quality to planned continuation was noted (0.106 (0.03), p = 0.001).
Counseling quality is independently associated with method satisfaction at the population level. The effect of counseling on planned continuation is partially mediated by method satisfaction.
Interventions to support person-centered contraceptive counseling promise to improve quality of care, patient experience with care, and reproductive outcomes.
我们使用经过验证的以患者为中心的避孕咨询（PCCC）量表，在两个东南部州的人群层面，考察咨询体验以及咨询质量、方法满意度与计划采用的避孕方法持续使用之间的关联。
我们使用了来自全州女性调查的数据，该调查是2017/18年阿拉巴马州和南卡罗来纳州基于概率抽样的育龄女性样本。我们纳入了使用避孕方法且报告在过去一年有过避孕咨询就诊的女性（n = 1265）。受访者对其最近一次咨询经历在四个PCCC项目上进行了评分。回归分析考察了咨询质量与感兴趣的结果之间的关系，路径分析考察了方法满意度在多大程度上介导了咨询质量对计划持续使用的影响。
超过半数的参与者（54%）报告接受了最佳避孕咨询。在调整模型中，最佳咨询与方法满意度相关（调整后风险比[aPR]=1.16；95%置信区间[CI]=1.04 - 1.29）。在双变量分析中，最佳咨询与计划停用略有相关，但在调整模型中减弱（aPR = 1.07；95% CI = 0.98 - 1.18）。在路径分析中，咨询质量影响方法满意度（0.143[0.045]，p = 0.001），方法满意度进而影响计划持续使用，同时控制PCCC（0.74[0.07]，p < 0.001）。咨询质量对计划持续使用的总间接效应显著（0.106[0.03]，p = 0.001），并且注意到从咨询质量到计划持续使用存在残余直接效应（0.106[0.03]，p = 0.001）。
在人群层面，咨询质量与方法满意度独立相关。咨询对计划持续使用的影响部分由方法满意度介导。
支持以患者为中心的避孕咨询的干预措施有望改善护理质量、患者护理体验和生殖结局。
