Wollum Alexandra, Moucheraud Corrina, Sabasaba Amon, Gipson Jessica D
Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States of America.
The UCLA Bixby Center on Population and Reproductive Health, Los Angeles, California, United States of America.
PLOS Glob Public Health. 2024 Jan 23;4(1):e0002810. doi: 10.1371/journal.pgph.0002810. eCollection 2024.
Access to removal of long-acting reversible contraception (LARCs) (e.g., implants and intrauterine devices (IUDs)) is an essential part of contraceptive care. We conducted a secondary analysis of cross-sectional survey data from a randomized controlled trial. We analyzed 5,930 client surveys and 259 provider surveys from 73 public sector facilities in Tanzania to examine the receipt of desired LARC removal services among clients and the association between receipt of desired LARC removal and person-centered care. We used provider survey data to contextualize these findings, describing provider attitudes and training related to LARC removals. All facilities took part in a larger randomized controlled trial to assess the Beyond Bias intervention, a provider-focused intervention to reduce provider bias on the basis of age, marital status, and parity. Thirteen percent of clients did not receive a desired LARC removal during their visit. Clients who were young, had lower perceived socioeconomic status, and visited facilities that did not take part in the Beyond Bias intervention were less likely to receive a desired removal. Clients who received a desired LARC removal reported higher levels of person-centered care (β = .07, CI: .02 - .11, p = < .01). Half of providers reported not being comfortable removing a LARC before its expiration (51%) or if they disagreed with the client's decision (49%). Attention is needed to ensure clients can get their LARCs removed when they want to ensure patient-centered care and protect client autonomy and rights. Interventions like the Beyond Bias intervention, may work to address provider-imposed barriers to LARC removals.
能够获得长效可逆避孕法(LARC,如皮下埋植剂和宫内节育器(IUD))取出服务是避孕护理的重要组成部分。我们对一项随机对照试验的横断面调查数据进行了二次分析。我们分析了来自坦桑尼亚73个公共部门机构的5930份客户调查问卷和259份提供者调查问卷,以研究客户中所需LARC取出服务的接受情况,以及所需LARC取出服务的接受与以患者为中心的护理之间的关联。我们使用提供者调查问卷数据来阐述这些发现,描述与LARC取出相关的提供者态度和培训情况。所有机构都参与了一项更大规模的随机对照试验,以评估“超越偏见”干预措施,这是一项以提供者为重点的干预措施,旨在减少基于年龄、婚姻状况和生育次数的提供者偏见。13%的客户在就诊期间未获得所需的LARC取出服务。年轻、自我感知社会经济地位较低且就诊于未参与“超越偏见”干预措施机构的客户获得所需取出服务的可能性较小。获得所需LARC取出服务的客户报告的以患者为中心的护理水平更高(β = 0.07,置信区间:0.02 - 0.11,p = < 0.01)。一半的提供者表示在LARC到期前(51%)或如果他们不同意客户的决定(49%)时,不愿意取出LARC。需要予以关注,以确保客户在希望取出LARC时能够实现,从而确保以患者为中心的护理,并保护客户的自主权和权利。像“超越偏见”干预措施这样的干预手段可能有助于解决提供者对LARC取出造成的障碍。