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Ereme K, Akullo K, Class QA, Hinz E. Patient Perceived Quality of Virtual Group Contraception Counseling. Open Access J Contracept 2024; 15:99-105. [PMID: 38978762 PMCID: PMC11230113 DOI: 10.2147/oajc.s467537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/21/2024] [Indexed: 07/10/2024] Open
Abstract
Introduction The study examines the feasibility, quality of counseling, and knowledge after a virtual Group Contraception Counseling (GCC) session. Methods At an urban academic hospital, we recruited English-speaking pregnant women aged 15-49 who had access to a video-enabled electronic device. Participants engaged in a standardized 45-minute educational session about contraceptive methods in groups of two to five persons conducted over a video conferencing platform. The primary outcome was participant perceived quality of contraception counseling measured by the Person-Centered Contraception Counseling (PCCC) scale. The secondary outcomes were knowledge change before and after counseling, and postpartum contraception uptake. We used an adjusted multivariable linear regression model to analyze knowledge scores. Results Twenty-two participants completed the study. Participants identified primarily as Black or Hispanic/Latinx (78%), in a partnership (50%), having completed college (59%), and having an annual income of less than $50,000 (78%). A total of 77% of participants recorded a perfect score for quality of counseling using the Person-Centered Contraceptive Counseling (PCCC) scale. There was an increase in knowledge after counseling (Mean difference (M)=0.07, p<0.01). Notably, certain subsets of participants had decrease in knowledge scores after counseling. Participants who used postpartum contraception were more likely to have increase in knowledge after counseling compared to those who did not (Mean difference (M)=0.09, p<0.01). Conclusion Our findings suggest virtual group contraception counseling is feasible for providing high-quality counseling and can possibly increase contraceptive knowledge.
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Affiliation(s)
- Keemi Ereme
- Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Kaidee Akullo
- Obstetrics and Gynecology, University of Illinois-Chicago, Chicago, IL, USA
| | - Quetzal A Class
- Obstetrics and Gynecology, University of Illinois-Chicago, Chicago, IL, USA
| | - Erica Hinz
- Obstetrics and Gynecology, University of Illinois-Chicago, Chicago, IL, USA
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2
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Stevens R, Machiyama K, Mavodza CV, Doyle AM. Misconceptions, Misinformation, and Misperceptions: A Case for Removing the "Mis-" When Discussing Contraceptive Beliefs. Stud Fam Plann 2023; 54:309-321. [PMID: 36753058 DOI: 10.1111/sifp.12232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Beliefs about contraception are commonly conceptualized as playing an important role in contraceptive decision-making. Interventions designed to address beliefs typically include counseling to dispel any "myths" or "misconceptions." These interventions currently show little evidence for impact in reducing beliefs. This commentary delves into the problems associated with using implicitly negative terminology to refer to contraceptive beliefs, which come laden with assumptions as to their validity. By conceptualizing women as getting it wrong or their beliefs as invalid, it sets the scene for dubious treatment of women's concerns and hampers the design of fruitful interventions to address them. To replace the multitude of terms used, we suggest using "belief" going forward to maintain value-free curiosity and remove any implicit assumptions about the origin or validity of a belief. We provide recommendations for measuring beliefs to help researchers understand the drivers and impacts of the belief they are measuring. Finally, we discuss implications for intervention design once different types of belief are better understood. We argue that tailored interventions by belief type would help address the root causes of beliefs and better meet women's broader contraceptive needs, such as the need for contraceptive autonomy and satisfaction.
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Affiliation(s)
- Rose Stevens
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK
| | - Kazuyo Machiyama
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Constancia Vimbayi Mavodza
- Department of Public Health and Policy, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Aoife M Doyle
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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3
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Sedlander E, Yilma H, Emaway D, Rimal RN. If fear of infertility restricts contraception use, what do we know about this fear? An examination in rural Ethiopia. Reprod Health 2022; 19:57. [PMID: 35698228 PMCID: PMC9195198 DOI: 10.1186/s12978-021-01267-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ethiopia has made great progress toward reducing unmet need for family planning and increasing contraception use over the last decade. However, almost one-quarter of women still have an unmet need. The primary reason for non-use is "method-related health concerns" and, within this broad category, the belief that using contraception will cause infertility is common. This belief extends beyond Ethiopia to low-, middle-, and high-income countries across the world. The objective of this paper is to examine associations with the belief that contraception use causes infertility and to subsequently suggest potential strategies to address this misperception. METHODS We collected data from women of reproductive age (between 15 and 49 years old) in 115 rural districts of Ethiopia (n = 706). Our main outcome variable was the belief that contraception causes infertility. We analyzed data, both individual-level factors and interpersonal factors, using nested logistic regression models. RESULTS Almost half of women in our sample (48.2%) believed that contraceptive use causes infertility. In the final model that included factors from both levels, self-efficacy to use contraception (AOR = 0.81, p < 0.05), visiting a health center and speaking to a provider about family planning in the last 12 months (AOR = 0.78, p < 0.05), and husband support of contraception (AOR = 0.77, p < 0.01) were associated with a reduction in the odds of believing that contraception causes infertility. The belief that infertility will result in abandonment from one's husband (AOR = 3.06, p < 0.001) was associated with an increase in the odds of holding the belief that contraception causes infertility. A home visit in the last 12 months from a health worker who discussed family planning was not associated with the belief that contraceptive use causes infertility. CONCLUSIONS Given that this belief is both salient and positively associated with other fears such as abandonment from one's husband, it is critical for family planning programs to address it. Communication campaigns or interventions that address this misperception among couples may diminish this belief, thereby increasing contraception use and reducing unmet need in rural Ethiopia.
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Affiliation(s)
- Erica Sedlander
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, USA.
| | - Hagere Yilma
- Department of Health Science, Boston University Sargent College, Boston, MA, USA
| | - Dessalew Emaway
- John Snow, Inc./ Last ten kilometers (L10K) Project, Addis Ababa, Ethiopia
| | - Rajiv N Rimal
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
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4
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Kim CS, Akers A, Muraleetharan D, Skolnik A, Garney W, Wilson K, Rao AS, Li Y. Modeling the impact of a health coaching intervention to prevent teen pregnancy. Prev Med Rep 2022; 26:101716. [PMID: 35169533 PMCID: PMC8829809 DOI: 10.1016/j.pmedr.2022.101716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 01/06/2022] [Accepted: 01/23/2022] [Indexed: 11/21/2022] Open
Abstract
Teenage pregnancy is an important public health issue in the United States, presenting significant health and economic risks to adolescents and the society. Health coaching is a potentially effective intervention in preventing teen pregnancy. In 2017, the Children's Hospital of Philadelphia implemented a health coaching program among sexually active teenage girls, which improved their contraceptive continuation rates. However, the cost-effectiveness of the health coaching program is not clear. We developed a microsimulation model of teen pregnancy that can predict the number of teen pregnancies and related birth outcomes. Model parameters were estimated from the literature and the health coaching program. The teen pregnancy model was used to assess how the program could influence direct health care costs and pregnancy outcomes. Our model projected that the health coaching program could prevent 15 teen pregnancies per 1000 adolescents compared to no intervention. The incremental cost-effectiveness ratio (ICER) for the intervention was $309 per pregnancy prevented, which was less than the willingness-to-pay threshold of $4,206 per pregnancy. Thus, the health coaching intervention was cost-effective. Our study provides promising data on the effectiveness and cost-effectiveness of a health coaching intervention to reduce the burden of teen pregnancies. Health practitioners should consider implementing the program for a longer term and at a larger scale.
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Affiliation(s)
- Chi-Son Kim
- Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, CT, United States
| | - Aletha Akers
- Vice President for Research, The Guttmacher Institute, New York, NY, United States
| | - Daenuka Muraleetharan
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
| | - Ava Skolnik
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Whitney Garney
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
| | - Kelly Wilson
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
| | - Aditi Sameer Rao
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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5
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Sekhon M, Cartwright M, Francis JJ. Development of a theory-informed questionnaire to assess the acceptability of healthcare interventions. BMC Health Serv Res 2022; 22:279. [PMID: 35232455 PMCID: PMC8887649 DOI: 10.1186/s12913-022-07577-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 02/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background The theoretical framework of acceptability (TFA) was developed in response to recommendations that acceptability should be assessed in the design, evaluation and implementation phases of healthcare interventions. The TFA consists of seven component constructs (affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy) that can help to identify characteristics of interventions that may be improved. The aim of this study was to develop a generic TFA questionnaire that can be adapted to assess acceptability of any healthcare intervention. Methods Two intervention-specific acceptability questionnaires based on the TFA were developed using a 5-step pre-validation method for developing patient-reported outcome instruments: 1) item generation; 2) item de-duplication; 3) item reduction and creation; 4) assessment of discriminant content validity against a pre-specified framework (TFA); 5) feedback from key stakeholders. Next, a generic TFA-based questionnaire was developed and applied to assess prospective and retrospective acceptability of the COVID-19 vaccine. A think-aloud method was employed with two samples: 10 participants who self-reported intention to have the COVID-19 vaccine, and 10 participants who self-reported receiving a first dose of the vaccine. Results 1) The item pool contained 138 items, identified from primary papers included in an overview of reviews. 2) There were no duplicate items. 3) 107 items were discarded; 35 new items were created to maximise coverage of the seven TFA constructs. 4) 33 items met criteria for discriminant content validity and were reduced to two intervention-specific acceptability questionnaires, each with eight items. 5) Feedback from key stakeholders resulted in refinement of item wording, which was then adapted to develop a generic TFA-based questionnaire. For prospective and retrospective versions of the questionnaire, no participants identified problems with understanding and answering items reflecting four TFA constructs: affective attitude, burden, perceived effectiveness, opportunity costs. Some participants encountered problems with items reflecting three constructs: ethicality, intervention coherence, self-efficacy. Conclusions A generic questionnaire for assessing intervention acceptability from the perspectives of intervention recipients was developed using methods for creating participant-reported outcome measures, informed by theory, previous research, and stakeholder input. The questionnaire provides researchers with an adaptable tool to measure acceptability across a range of healthcare interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07577-3.
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Affiliation(s)
- Mandeep Sekhon
- School of Health Sciences, City University of London, Northampton Square, London, EC1V 0JB, UK. .,Department of Population Health Sciences, Faculty of life Sciences and Medicine, Kings College London, London, SE1 1UL, UK.
| | - Martin Cartwright
- School of Health Sciences, City University of London, Northampton Square, London, EC1V 0JB, UK
| | - Jill J Francis
- School of Health Sciences, City University of London, Northampton Square, London, EC1V 0JB, UK.,Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC, 3010, Australia.,Centre of Implementation Research, Ottawa Hospital Research Institute - General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
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6
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Bennett RJ, Kosovich E, Cohen S, Lo C, Logan K, Olaithe M, Eikelboom R. Hearing Aid Review Appointments: Attendance and Effectiveness. Am J Audiol 2021; 30:1058-1066. [PMID: 34709951 DOI: 10.1044/2021_aja-21-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This study aimed to (a) identify participant factors associated with hearing aid review (HAR) appointment attendance, (b) investigate whether the completion of self-report survey identifying hearing aid-related problems affects HAR appointment attendance, and (c) investigate whether hearing aid problems and hearing aid management deficiencies are adequately addressed during HAR appointments. METHOD A prospective cohort study of adult hearing aid owners recruited from a single hearing clinic in Western Australia. Potential participants were invited to an annual HAR appointment via postal letter. The invitation included a paper-based self-report survey evaluating either (a) hearing aid problems, (b) hearing aid management skills, or (c) hearing aid outcomes, depending on which intervention/control group the potential participants were assigned to, and a reply paid addressed envelope. Two months later, potential participants were sent all three paper-based self-report surveys, irrespective of whether they had attended or not attended an HAR appointment. RESULTS (a) There was no significant difference in gender or source of funding for hearing services between HAR appointment attendees and nonattendees. HAR nonattendees lived a greater distance from their clinic and were younger than attendees. (b) Survey completion did not influence HAR appointment attendance rates. (c) A significant reduction in individuals' self-reported hearing aid problems was recorded following the attendance at the HAR appointment. No significant changes in hearing aid management skills or overall hearing aid outcomes were detected. CONCLUSIONS Long travel distances may be a barrier to attendance at review appointments. HAR appointments appear to be effective in improving hearing aid problems.
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Affiliation(s)
- Rebecca J. Bennett
- Ear Science Institute Australia, Subiaco, Western Australia
- Ear Sciences Centre, The University of Western Australia, Nedlands, Australia
| | - Erin Kosovich
- Ear Science Institute Australia, Subiaco, Western Australia
- Ear Sciences Centre, The University of Western Australia, Nedlands, Australia
| | - Steff Cohen
- Ear Science Institute Australia, Subiaco, Western Australia
- Ear Sciences Centre, The University of Western Australia, Nedlands, Australia
| | - Cara Lo
- Ear Science Institute Australia, Subiaco, Western Australia
- Ear Sciences Centre, The University of Western Australia, Nedlands, Australia
| | - Kevin Logan
- Ear Science Institute Australia, Subiaco, Western Australia
- Ear Sciences Centre, The University of Western Australia, Nedlands, Australia
| | - Michelle Olaithe
- School of Psychology, The University of Western Australia, Nedlands, Australia
| | - Robert Eikelboom
- Ear Science Institute Australia, Subiaco, Western Australia
- Ear Sciences Centre, The University of Western Australia, Nedlands, Australia
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
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7
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Karakoyun T, Podhaisky HP, Frenz AK, Schuhmann-Giampieri G, Ushikusa T, Schröder D, Zvolanek M, Lopes Da Silva Filho A. Digital Medical Device Companion (MyIUS) for New Users of Intrauterine Systems: App Development Study. JMIR Med Inform 2021; 9:e24633. [PMID: 34255688 PMCID: PMC8317031 DOI: 10.2196/24633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/04/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Women choosing a levonorgestrel-releasing intrauterine system may experience changes in their menstrual bleeding pattern during the first months following placement. Objective Although health care professionals (HCPs) can provide counseling, no method of providing individualized information on the expected bleeding pattern or continued support is currently available for women experiencing postplacement bleeding changes. We aim to develop a mobile phone–based medical app (MyIUS) to meet this need and provide a digital companion to women after the placement of the intrauterine system. Methods The MyIUS app is classified as a medical device and uses an artificial intelligence–based bleeding pattern prediction algorithm to estimate a woman’s future bleeding pattern in terms of intensity and regularity. We developed the app with the help of a multidisciplinary team by using a robust and high-quality design process in the context of a constantly evolving regulatory landscape. The development framework consisted of a phased approach including ideation, feasibility and concept finalization, product development, and product deployment or localization stages. Results The MyIUS app was considered useful by HCPs and easy to use by women who were consulted during the development process. Following the launch of the sustainable app in selected pilot countries, performance metrics will be gathered to facilitate further technical and feature updates and enhancements. A real-world performance study will also be conducted to allow us to upgrade the app in accordance with the new European Commission Medical Device legislation and to validate the bleeding pattern prediction algorithm in a real-world setting. Conclusions By providing a meaningful estimation of bleeding patterns and allowing an individualized approach to counseling and discussions about contraceptive method choice, the MyIUS app offers a useful tool that may benefit both women and HCPs. Further work is needed to validate the performance of the prediction algorithm and MyIUS app in a real-world setting.
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Affiliation(s)
| | | | | | | | | | - Daniel Schröder
- BAYOOMED Medical Software Development, BAYOONET AG, Darmstadt, Germany
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8
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Schwandt HM, Boulware A, Corey J, Herrera A, Hudler E, Imbabazi C, King I, Linus J, Manzi I, Merritt M, Mezier L, Miller A, Morris H, Musemakweli D, Musekura U, Mutuyimana D, Ntakarutimana C, Patel N, Scanteianu A, Shemeza BE, Sterling-Donaldson G, Umutoni C, Uwera L, Zeiler M, Feinberg S. "… the way we welcome them is how we will lead them to love family planning.": family planning providers in Rwanda foster compassionate relationships with clients despite workplace challenges. BMC Health Serv Res 2021; 21:293. [PMID: 33794871 PMCID: PMC8017655 DOI: 10.1186/s12913-021-06282-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rwanda has markedly increased the nation's contraceptive use in a short period of time, tripling contraceptive prevalence in just 5 years between 2005 and 2010. An integral aspect of family planning programs is the interactions between family planning providers and clients. This study aims to understand the client-provider relationship in the Rwandan family planning program and to also examine barriers to those relationships. METHODS This qualitative study in Rwanda utilized convenience sampling to include eight focus group discussions with family planning providers, both family planning nurses and community health workers, as well as in-depth interviews with 32 experienced modern contraceptive users. Study participants were drawn from the two districts in Rwanda with the highest and lowest modern contraceptive rates, Musanze and Nyamasheke, respectively Data analysis was guided by the thematic content approach, Atlas.ti 8 was utilized for coding the transcripts and collating the coding results, and Microsoft Excel for analyzing the data within code. RESULTS Data analysis revealed that, despite workplace related challenges - including inadequate staffing, training, and resources, relationships between providers and clients are strong. Family planning providers work hard to understand, learn from, and support clients in their initiation and sustained use of contraceptives. CONCLUSION Given the existing context of purposeful efforts on the part of family planning providers to build relationships with their clients, if the current level of government support for family planning service provision is enhanced, Rwanda will likely sustain many current users of contraception and engage even more Rwandans in contraceptive services in the future.
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Affiliation(s)
- Hilary M Schwandt
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA.
| | - Angel Boulware
- Spelman College, 350 Spelman Ln SW, Atlanta, GA, 30314, USA
| | - Julia Corey
- Wheaton College, 26 E Main St, Norton, MA, 02766, USA
| | - Ana Herrera
- Northwest Vista Community College, 3535 N Ellison Dr., San Antonio, TX, 78251, USA
| | - Ethan Hudler
- Whatcom Community College, 237 W Kellogg Rd, Bellingham, WA, 98226, USA
| | | | - Ilia King
- Xavier University, 1 Drexel Dr, New Orleans, LA, 70125, USA
| | | | | | - Madelyn Merritt
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | - Lyn Mezier
- SUNY Oswego, 7060 NY-104, Oswego, NY, 13126, USA
| | - Abigail Miller
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | - Haley Morris
- Western Oregon University, 345 Monmouth Ave N, Monmouth, OR, 97361, USA
| | | | - Uwase Musekura
- Eastern Oregon University, One University Blvd, La Grande, OR, 97850, USA
| | | | | | - Nirali Patel
- Arcadia University, 450 S Easton Rd, Glenside, PA, 19038, USA
| | | | | | | | | | | | - Madeleine Zeiler
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | - Seth Feinberg
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
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9
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Stephenson J, Bailey JV, Blandford A, Brima N, Copas A, D'Souza P, Gubijev A, Hunter R, Shawe J, Rait G, Oliver S. An interactive website to aid young women's choice of contraception: feasibility and efficacy RCT. Health Technol Assess 2020; 24:1-44. [PMID: 33164729 DOI: 10.3310/hta24560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Effective use of contraception can reduce numbers of unintended pregnancies, but misunderstandings and concerns about contraception abound. Increasingly, women seek health-care information online. OBJECTIVES To develop an interactive website to aid informed choice of contraceptive method, including long-acting reversible contraception (Phase I), and test its effectiveness in a parallel, single-blind randomised trial (Phase II). Approval came from London - Camden & King's Cross Research Ethics Committee (reference 17/LO/0112). SETTING AND PARTICIPANTS For both phases, women aged 15-30 years were recruited from general practice, sexual health services, maternity services, community pharmacies and an abortion service. DESIGN In Phase I, we conducted three systematic literature reviews, a review of YouTube (YouTube, LLC, San Bruno, CA, USA) videos about contraception, and focus groups and interviews with young women to explore barriers to and concerns and misperceptions about contraception. We then iteratively co-designed an interactive website, Contraception Choices [URL: www.contraceptionchoices.org (accessed June 2020)], with young women and a software company. In Phase II, we evaluated the website through a randomised trial that began as a feasibility trial. Early demand for Contraception Choices stimulated a design change from a feasibility to an efficacy trial, with follow-up for clinical outcomes at 3 and 6 months. A randomisation list was incorporated into the trial software program to allocate participants to the intervention (website) or control group (standard care). INTERVENTION Contraception Choices is a co-designed, evidence-based, interactive website to aid informed choice of contraception. It provides information about different methods, addresses common concerns and offers tailored contraceptive options in response to individual preferences. MAIN OUTCOME MEASURES Qualitative - participant views and experience of the intervention, assessed through qualitative interviews. Quantitative primary outcomes - follow-up rate at 6 months in the initial feasibility trial, using a long-acting reversible contraception method, and satisfaction with contraceptive method at 6 months in the efficacy trial. RESULTS A total of 927 women were randomised online to the website (n = 464) or control group (n = 463), of whom 739 (80%) provided follow-up data at 6 months [786 women (85%) provided data at 3 and/or 6 months that were included in the analysis of primary outcomes]. There was little difference between groups in the proportion using long-acting reversible contraception at 6 months [30.4% intervention vs. 31.0% control, adjusted odds ratio after imputation 0.87 (95% confidence interval 0.60 to 1.27)] or in satisfaction with contraceptive method [proportion being 'satisfied' or 'very satisfied', 82.6% intervention vs. 82.1% control, adjusted odds ratio 0.93 (95% confidence interval 0.69 to 1.25)]. Qualitative evaluation indicated highly positive views about the website and increased knowledge of contraceptive methods that could dispel misperceptions. Women appreciated having information tailored to their specific needs and felt better prepared before consultations. LIMITATIONS We did not include intermediate measures, such as knowledge of contraceptive methods, intention to change method or confidence in discussing contraception with a health-care professional, which may have indicated other benefits of using the website. In future, the website should be studied in different settings (e.g. schools and in routine practice) to see whether or not it improves the quality or efficiency of contraceptive consultations. CONCLUSIONS Our systematic review indicated wide-ranging influences on women's use of contraception globally. The website, Contraception Choices, was very popular with young women and contraception service providers. It was not associated with statistically significant differences in use of long-acting reversible contraception or satisfaction with contraceptive method at 6 months. TRIAL REGISTRATION Current Controlled Trials ISRCTN13247829. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 56. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Judith Stephenson
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Julia V Bailey
- Department of Primary Care and Population Health, University College London, Royal Free Hospital, London, UK
| | - Ann Blandford
- UCL Interaction Centre (UCLIC), University College London, London, UK
| | - Nataliya Brima
- Institute for Global Health, University College London, London, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Preethy D'Souza
- Department of Social Science, UCL Institute of Education, University College London, London, UK
| | - Anasztazia Gubijev
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | | | - Jill Shawe
- Institute of Health and Community, University of Plymouth, Plymouth, UK
| | - Greta Rait
- PRIMENT Clinical Trials Unit, Department of Primary Care and Population Health, University College London, Royal Free Hospital, London, UK
| | - Sandy Oliver
- Department of Social Science, UCL Institute of Education, University College London, London, UK.,Africa Centre for Evidence, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
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10
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Contraceptive use among sexually active women living with HIV in western Ethiopia. PLoS One 2020; 15:e0237212. [PMID: 32760140 PMCID: PMC7410321 DOI: 10.1371/journal.pone.0237212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 07/22/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Contraception can help to meet family planning goals for women living with HIV (WLHIV) as well as to support the prevention of mother to child transmission of HIV (PMTCT). However, there is little research into the contraceptive practice among sexually active WLHIV in Ethiopia. Therefore, we aimed to examine contraceptive practice among sexually active WLHIV in western Ethiopia and identify the factors that influenced such practice using the Health Belief Model (HBM). Methods A facility-based cross-sectional survey of 360 sexually active WLHIV was conducted from 19th March to 22nd June 2018 in western Ethiopia. The eligible participants were WLHIV aged between 18 and 49 years who reported being fecund and sexually active within the previous six months but were not pregnant and not wanting to have another child within two years. Modified Poisson regression analyses were conducted to identify factors that influenced contraceptive practice among sexually active WLHIV in western Ethiopia. Results Among sexually active WLHIV (n = 360), 75% used contraception with 25% having unmet needs. Of the contraceptive users, 44.8% used injectables, 37.4% used condoms and 28.5% used implants. Among 152 recorded births in the last five years, 17.8% were reported as mistimed and 25.7% as unwanted. Compared to WLHIV having no child after HIV diagnosis, having two or more children after HIV diagnosis (Adjusted Prevalence Ratio [APR] = 1.31; 95%CI 1.09–1.58) was associated with increased risk of contraceptive practice. However, sexually active unmarried WLHIV (APR = 0.69; 95%CI 0.50–0.95) were less likely to use any contraception compared to their sexually active married counterparts. Importantly, high perceived susceptibility (APR = 1.49; 95%CI 1.20–1.86) and medium perceived susceptibility (APR = 1.55; 95%CI 1.28–1.87) towards unintended pregnancy were associated with higher risk of contraceptive use than WLHIV with low perceived susceptibility. Conclusions Although contraceptive use amongst sexually active WLHIV was found to be high, our findings highlight the need for strengthening family planning services given the high rate of unintended pregnancies, the high rate of unmet needs for contraception, as well as the lower efficacy with some of the methods. Our findings also suggest that the HBM would be a valuable framework for healthcare providers, programme planners and policymakers to develop guidelines and policies for contraceptive counselling and choices.
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Zgliczynska M, Kocaj K, Szymusik I, Dutsch-Wicherek MM, Ciebiera M, Kosinska-Kaczynska K. Levonorgestrel-Releasing Intrauterine System as a Contraceptive Method in Nulliparous Women: A Systematic Review. J Clin Med 2020; 9:jcm9072101. [PMID: 32635369 PMCID: PMC7408997 DOI: 10.3390/jcm9072101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/15/2020] [Accepted: 06/29/2020] [Indexed: 01/16/2023] Open
Abstract
The aim of this review was to summarize the available evidence about the use of levonorgestrel-releasing intrauterine system (LNG-IUS) as a contraceptive method in nulliparous women. For this purpose, studies evaluating the efficacy, safety, bleeding pattern, satisfaction and discontinuation of the levonorgestrel-releasing intrauterine system in nulliparous women were analyzed. Only original research articles published in English between 1990–27th March 2020 were considered eligible. Reviews, book chapters, case studies, conference papers, opinions, editorials and letters were excluded. The systematic literature search of PubMed/MEDLINE, Scopus, Embase and Cochrane Library databases identified 816 articles, 23 of which were analyzed. The available evidence indicates that LNG-IUS is an effective and safe contraceptive method for nulliparous women that achieves high levels of satisfaction among patients. Moreover, nulliparous women seem to experience fewer expulsions than parous ones. Bleeding pattern is acceptable for the majority of patients, and bleeding disorders mainly occur in the first months after the insertion. More in-depth, long-term prospective studies are needed in this patient group to determine risk factors for the occurrence of side effects and associated discontinuations, which should not, however, delay the wider use of the method in this group, given the number of advantages.
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Affiliation(s)
- Magdalena Zgliczynska
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (M.Z.); (K.K.-K.)
| | - Karol Kocaj
- Medical University of Silesia, 40-055 Katowice, Poland;
| | - Iwona Szymusik
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland;
| | | | - Michal Ciebiera
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (M.Z.); (K.K.-K.)
- Correspondence: ; Tel.: + 48-22-5690274
| | - Katarzyna Kosinska-Kaczynska
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; (M.Z.); (K.K.-K.)
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Alomair N, Alageel S, Davies N, Bailey JV. Factors influencing sexual and reproductive health of Muslim women: a systematic review. Reprod Health 2020; 17:33. [PMID: 32138744 PMCID: PMC7059374 DOI: 10.1186/s12978-020-0888-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 02/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Islamic societies, issues related to sexual and reproductive health (SRH) are rarely discussed and considered sensitive subjects. This review aimed to identify any personal, religious, cultural, or structural barriers to SRH service and education among Muslim women worldwide. METHODS A search for qualitative and quantitative studies was conducted on seven electronic databases. A narrative synthesis using thematic analysis was conducted. RESULTS Fifty-nine studies were included from 22 countries: 19 qualitative, 38 quantitative and two mixed methods. Many Muslim women have poor SRH knowledge, and negative attitudes which influence their access to, and use of SRH services. Barriers to contraception use among Muslim women included a lack of basic reproductive knowledge, insufficient knowledge about contraception, misconceptions, and negative attitudes. Women had negative attitudes towards family planning for limiting the number of children but not for child spacing, which reflected religious views towards family planning. Religious and cultural beliefs were barriers to contraception use and access to SRH services and information. Family and the community have a significant impact on women's contraceptive use and access to SRH services. Husband and family opposition played a significant role in contraception access and use. Fear of stigmatization and being labelled as having pre-marital sexual relations among unmarried women acted as the main barrier to accessing contraception and seeking SRH information and services. CONCLUSION The findings reveal that there are multiple levels of factors that influence Muslim women's SRH. Poor SRH knowledge and practices among Muslim women is complex matter that is affected by personal, community, cultural, religious factors and existing policies and regulations. All these factors overlap and are affected by each other. There is an urgent need for interventions addressing modifiable barriers to SRH education and services to improve knowledge, informed choice and access to services to facilitate better sexual and reproductive wellbeing for Muslim women. It is important to note that while this review aimed to report findings on Muslim women, we acknowledge that significant variations exist within every culture and religion.
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Affiliation(s)
- Noura Alomair
- Research Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - Samah Alageel
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Nathan Davies
- Research Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Julia V Bailey
- Research Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
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Reiss K, Andersen K, Pearson E, Biswas K, Taleb F, Ngo TD, Hossain A, Barnard S, Smith C, Carpenter J, Menzel J, Footman K, Keenan K, Douthwaite M, Reena Y, Mahmood HR, Tabbassum T, Colombini M, Bacchus L, Church K. Unintended Consequences of mHealth Interactive Voice Messages Promoting Contraceptive Use After Menstrual Regulation in Bangladesh: Intimate Partner Violence Results From a Randomized Controlled Trial. GLOBAL HEALTH: SCIENCE AND PRACTICE 2019; 7:386-403. [PMID: 31558596 PMCID: PMC6816818 DOI: 10.9745/ghsp-d-19-00015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/21/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mobile phones for health (mHealth) hold promise for delivering behavioral interventions. We evaluated the effect of automated interactive voice messages promoting contraceptive use with a focus on long-acting reversible contraceptives (LARCs) among women in Bangladesh who had undergone menstrual regulation (MR), a procedure to "regulate the menstrual cycle when menstruation is absent for a short duration." METHODS We recruited MR clients from 41 public- and private-sector clinics immediately after MR. Eligibility criteria included having a personal mobile phone and consenting to receive messages about family planning by phone. We randomized participants remotely to an intervention group that received at least 11 voice messages about contraception over 4 months or to a control group (no messages). The primary outcome was LARC use at 4 months. Adverse events measured included experience of intimate partner violence (IPV). Researchers recruiting participants and 1 analyst were blinded to allocation groups. All analyses were intention to treat. The trial is registered with ClinicalTrials.gov (NCT02579785). RESULTS Between December 2015 and March 2016, 485 women were allocated to the intervention group and 484 to the control group. We completed follow-up on 389 intervention and 383 control participants. Forty-eight (12%) participants in the intervention group and 59 (15%) in the control group reported using a LARC method at 4 months (adjusted odds ratio [aOR] using multiple imputation=0.95; 95% confidence interval [CI]=0.49 to 1.83; P=.22). Reported physical IPV was higher in the intervention group: 42 (11%) intervention versus 25 (7%) control (aOR=1.97; 95% CI=1.12 to 3.46; P=.03) when measured using a closed question naming acts of violence. No violence was reported in response to an open question about effects of being in the study. CONCLUSIONS The intervention did not increase LARC use but had an unintended consequence of increasing self-reported IPV. Researchers and health program designers should consider possible negative impacts when designing and evaluating mHealth and other reproductive health interventions. IPV must be measured using closed questions naming acts of violence.
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Affiliation(s)
- Kate Reiss
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | | | | | | | | | | | - Altaf Hossain
- Association for Prevention of Septic Abortion, Bangladesh, Dhaka, Bangladesh
| | - Sharmani Barnard
- School of Population Health and Environmental Sciences, King's College, London, UK
| | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - James Carpenter
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Katherine Keenan
- School of Geography and Sustainable Development, University of St. Andrews, St. Andrews, UK
| | | | | | | | | | - Manuela Colombini
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Loraine Bacchus
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Mack N, Crawford TJ, Guise J, Chen M, Grey TW, Feldblum PJ, Stockton LL, Gallo MF. Strategies to improve adherence and continuation of shorter-term hormonal methods of contraception. Cochrane Database Syst Rev 2019; 4:CD004317. [PMID: 31013349 PMCID: PMC6478403 DOI: 10.1002/14651858.cd004317.pub5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Worldwide, hormonal contraceptives are among the most popular reversible contraceptives. Despite high perfect-use effectiveness rates, typical-use effectiveness rates for shorter-term methods such as oral and injectable contraceptives are much lower. In large part, this disparity reflects difficulties in ongoing adherence to the contraceptive regimen and low continuation rates. Correct use of contraceptives to ensure effectiveness is vital to reducing unintended pregnancy. OBJECTIVES To determine the effectiveness of strategies aiming to improve adherence to, and continuation of, shorter-term hormonal methods of contraception compared with usual family planning care. SEARCH METHODS We searched to July 2018 in the following databases (without language restrictions): The Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 7), PubMed via MEDLINE, POPLINE, Web of Science, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP). SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing strategies aimed to facilitate adherence and continuation of shorter-term hormonal methods of contraception (such as oral contraceptives (OCs), injectable depot medroxyprogesterone acetate (DMPA or Depo-Provera), intravaginal ring, or transdermal patch) with usual family planning care in reproductive age women seeking to avoid pregnancy. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. Primary outcomes were continuation or discontinuation of contraceptive method, rates of discontinuation due to adverse events (menstrual disturbances and all other adverse events), and adherence to method use as indicated by missed pills and on-time/late injections. Pregnancy was a secondary outcome. MAIN RESULTS We included 10 RCTs involving 6242 women. Six trials provided direct in-person counseling using either multiple counseling contacts or multiple components during one visit. Four trials provided intensive reminders of appointments or next dosing, of which two provided additional educational health information as well as reminders. All trials stated 'usual care' as the comparison.The certainty of the evidence ranged from very low to moderate. Main limitations were risk of bias (associated with poor reporting of methodological detail, lack of blinding, and incomplete outcome data), inconsistency, indirectness, and imprecision.Continuation of hormonal contraceptive methodsIt is uncertain whether intensive counseling improves continuation of hormonal contraceptive methods compared with usual care (OR 1.28, 95% CI 1.07 to 1.54; 2624 participants; 6 studies; I2 = 79%; very low certainty evidence). The evidence suggested: if the chance of continuation with usual care is 39%, the chance of continuation with intensive counseling would be between 41% and 50%. The overall pooled OR suggested continuation of improvement, however, when stratified by contraceptive method type, the positive results were restricted to DMPA.It is uncertain whether reminders (+/- educational information) improve continuation of hormonal contraceptive methods compared with usual care (OR 1.33, 95% CI 1.03 to 1.73; 933 participants; 2 studies; I2 = 69%; very low certainty evidence).The evidence suggested: if the chance of continuation with usual care is 52%, the chance of continuation with reminders would be between 52% and 65%.Discontinuation due to adverse eventsThe evidence suggested that counseling may be associated with a decreased rate of discontinuation due to adverse events compared with usual care, with a lower rate of discontinuation due to menstrual disturbances (OR 0.20, 95% CI 0.11 to 0.37; 350 participants; 1 study; low certainty evidence), but may make little or no difference to all other adverse events (OR 0.73, 95% CI 0.36 to 1.47; 350 participants; 1 study; low certainty evidence). The evidence suggested: if the chance of discontinuation with usual care due to menstrual disturbances is 32%, the chance of discontinuation with intensive counseling would be between 5% and 15%; and that if the chance of discontinuation with usual care due to other adverse events is 55%, the chance of discontinuation with intensive counseling would be between 30% and 64%.Discontinuation was not reported among trials that investigated the use of reminders (+/- educational information).Adherence Adherence was not reported among trials that investigated the use of intensive counseling.Among trials that investigated reminders (+/- educational information), there was no conclusive evidence of a difference in adherence as indicated by missed pills (MD 0.80, 95% CI -1.22 to 2.82; 73 participants; 1 study; moderate certainty evidence) or by on-time injections (OR 0.84, 95% CI 0.54 to 1.29; 350 participants; 2 studies; I2 = 0%; low certainty evidence). The evidence suggested: if the chance of adherence to method use as indicated by on-time injections with usual care is 50%, the chance of adherence with method use as indicated by on-time injections with reminders would be between 35% and 56%.PregnancyThere was no conclusive evidence of a difference in rates of pregnancy between intensive counseling and usual care (OR 1.24, 95% CI 0.98 to 1.57; 1985 participants; 3 studies; I2 = 0%, very low certainty evidence). The evidence suggested: if the chance of pregnancy with usual care is 18%, the chance of pregnancy with counseling would be between 18% and 25%.Pregnancy was not reported among trials that investigated the use of reminders (+/- educational information). AUTHORS' CONCLUSIONS Despite the importance of this topic, studies have not been published since the last review in 2013 (nine studies) with only one study added in 2019 that neither changed the results nor improved the certainty of evidence.Overall, the certainty of evidence for strategies to improve adherence and continuation of contraceptives is low. Intensive counseling and reminders (with or without educational information) may be associated with improved continuation of shorter-term hormonal contraceptive methods when compared with usual family planning care. However, this should be interpreted with caution due to the low certainty of the evidence. Included trials used a variety of shorter-term hormonal contraceptive methods which may account for the high heterogeneity. It is possible that the effectiveness of strategies for improving adherence and continuation are contingent on the contraceptive method targeted. There was limited reporting of objectively measurable outcomes (e.g. electronic monitoring device) among included studies. Future trials would benefit from standardized definitions and measurements of adherence, and consistent terminology for describing interventions and comparisons. Further research requires larger studies, follow-up of at least one year, and improved reporting of trial methodology.
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Affiliation(s)
- Natasha Mack
- FHI 360Research Utilization359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Tineke J Crawford
- The University of AucklandLiggins Institute85 Park RoadGraftonAucklandNew Zealand1023
| | - Jeanne‐Marie Guise
- Oregon Health and Science UniversityDepartments of Obstetrics and Gynecology, Medical Informatics and Clinical Epidemiology, Public Health & Preventive Medicine, and Emergency Medicine3181 SW Sam Jackson Park Road, Mailcode L458PortlandOregonUSA97239‐3098
| | - Mario Chen
- FHI 360Biostatistics359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Thomas W Grey
- FHI 360Behavioral Epidemiological Clinical Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Paul J Feldblum
- FHI 360Behavioral Epidemiological Clinical Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | | | - Maria F Gallo
- The Ohio State UniversityDivision of EpidemiologyColumbusOhioUSA
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Activity of a Long-Acting Injectable Bedaquiline Formulation in a Paucibacillary Mouse Model of Latent Tuberculosis Infection. Antimicrob Agents Chemother 2019; 63:AAC.00007-19. [PMID: 30745396 PMCID: PMC6437534 DOI: 10.1128/aac.00007-19] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/05/2019] [Indexed: 11/20/2022] Open
Abstract
The potent antituberculosis activity and long half-life of bedaquiline make it an attractive candidate for use in long-acting/extended-release formulations for the treatment of latent tuberculosis infection (LTBI). Our objective was to evaluate a long-acting injectable (LAI) bedaquiline formulation in a validated paucibacillary mouse model of LTBI. The potent antituberculosis activity and long half-life of bedaquiline make it an attractive candidate for use in long-acting/extended-release formulations for the treatment of latent tuberculosis infection (LTBI). Our objective was to evaluate a long-acting injectable (LAI) bedaquiline formulation in a validated paucibacillary mouse model of LTBI. Following immunization with Mycobacterium bovis rBCG30, BALB/c mice were challenged by aerosol infection with M. tuberculosis H37Rv. Treatment began 13 weeks after challenge infection with one of the following regimens: an untreated negative-control regimen; positive-control regimens of daily rifampin (10 mg/kg of body weight), once-weekly rifapentine (15 mg/kg) and isoniazid (50 mg/kg), or daily bedaquiline (25 mg/kg); test regimens of one, two, or three monthly doses of LAI bedaquiline at 160 mg/dose (BLAI-160); and test regimens of daily bedaquiline at 2.67 mg/kg (B2.67), 5.33 mg/kg (B5.33), or 8 mg/kg (B8) to deliver the same total amount of bedaquiline as one, two, or three doses of BLAI-160, respectively. All drugs were administered orally, except for BLAI-160 (intramuscular injection). The primary outcome was the decline in M. tuberculosis lung CFU counts during 12 weeks of treatment. The negative- and positive-control regimens performed as expected. One, two, and three doses of BLAI-160 resulted in decreases of 2.9, 3.2, and 3.5 log10 CFU/lung, respectively, by week 12. Daily oral dosing with B2.67, B5.33, and B8 decreased lung CFU counts by 1.6, 2.8, and 4.1 log10, respectively. One dose of BLAI-160 exhibited activity for at least 12 weeks. The sustained activity of BLAI-160 indicates that it shows promise as a short-course LTBI treatment requiring few patient encounters to ensure treatment completion.
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Emtell Iwarsson K, Larsson EC, Gemzell-Danielsson K, Essén B, Klingberg-Allvin M. Contraceptive use among migrant, second-generation migrant and non-migrant women seeking abortion care: a descriptive cross-sectional study conducted in Sweden. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:bmjsrh-2018-200171. [PMID: 30665889 DOI: 10.1136/bmjsrh-2018-200171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/19/2018] [Accepted: 12/27/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The objective of this study was to compare ever-in life contraception use, use of contraception at current conception, and planned use of contraception after an induced abortion, among three groups of women: migrants, second-generation migrants and non-migrant women, and to compare the types of contraception methods used and intended for future use among the three groups of women. METHODS The cross-sectional study administered a questionnaire face-to-face to women aged 18 years and older who were seeking abortion care at one of six abortion clinics in Stockholm County from January to April 2015. RESULTS The analysis included 637 women. Migrants and second-generation migrants were less likely to have used contraception historically, at the time of the current conception, and to plan to use contraception after their induced abortion compared with non-migrant women. Historically, non-migrants had used pills (89%) and withdrawal (24%) while migrants had used the copper intrauterine device (24%) to a higher extent compared to the other two groups of women. Both the migrants (65%) and second-generation migrants (61%) were more likely than the non-migrants (48%) to be planning to use long-acting reversible contraception. CONCLUSIONS Lower proportions of contraception use were found in migrants and second-generation migrants than in non-migrants. In addition, there were significant differences in the types of contraception methods used historically and intended for future use.
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Affiliation(s)
- Karin Emtell Iwarsson
- Department of Women's and Children's Health, Karolinska Institutet, WHO-Centre, QB:84, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Elin C Larsson
- Department of Women's and Children's Health, Karolinska Institutet, WHO-Centre, QB:84, Karolinska University Hospital Solna, Stockholm, Sweden
- Department of Women's and Children's Health/International Maternal and Child Health (IMCH), Uppsala University, Akademiska Hospital, Uppsala, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, WHO-Centre, QB:84, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Birgitta Essén
- Department of Women's and Children's Health/International Maternal and Child Health (IMCH), Uppsala University, Akademiska Hospital, Uppsala, Sweden
| | - Marie Klingberg-Allvin
- Department of Women's and Children's Health, Karolinska Institutet, WHO-Centre, QB:84, Karolinska University Hospital Solna, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Cover J, Ba M, Drake JK, NDiaye MD. Continuation of self-injected versus provider-administered contraception in Senegal: a nonrandomized, prospective cohort study. Contraception 2018; 99:137-141. [PMID: 30439358 PMCID: PMC6367564 DOI: 10.1016/j.contraception.2018.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/02/2018] [Accepted: 11/05/2018] [Indexed: 11/08/2022]
Abstract
Objectives The primary objective of this study was to compare the 12-month continuation rate for women who self-injected subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) with that for women receiving intramuscular depot-medroxyprogesterone acetate (DMPA-IM) from a provider. This research contributes to the broader goal of identifying solutions to support women to use contraception for their full desired duration. Study design Participants were clients from 13 clinics in the Dakar and Thiés regions of Senegal who had decided to use injectable contraception prior to enrollment. They chose self-injection of DMPA-SC or provider administration of DMPA-IM. Self-injectors were trained and given three units of DMPA-SC. The provider-injected group received DMPA-IM and returned to the clinics for future injections. We interviewed participants at baseline and after the second, third and fourth injections (the equivalent of 12 months of contraceptive coverage). We employed Kaplan–Meier methods to estimate continuation probabilities, with a log-rank test to compare differences between groups. A multivariate Cox regression identified factors correlated with discontinuation. Results The 12-month continuation rate for 650 women self-injecting DMPA-SC was 80.2%, while that for 649 women receiving DMPA-IM from a provider was 70.4% (p<.01). The difference in continuation between self-injectors and those receiving DMPA from a provider remained significant in a multivariate Cox regression model. The primary reason for discontinuation in both groups (44.7% self-injected; 44.5% provider-injected) was forgetting to reinject or reinjecting late. Fewer women reported side effects in the self-injection group than in the provider-administered group. Conclusions The higher 12-month continuation rate for women self-injecting DMPA-SC relative to provider-administered DMPA-IM suggests that self-injection may help prevent pregnancy more consistently and continuously. Implications Discontinuation of injectable contraception among women wishing to avoid pregnancy may increase unmet need in francophone West Africa. This study showed higher 12-month continuation rates for women who self-injected DMPA-SC, suggesting that this delivery method may improve injectable continuation.
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Affiliation(s)
- Jane Cover
- PATH, PO Box 900922, Seattle, WA 98109, USA.
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Sedlander E, Bingenheimer JB, Thiongo M, Gichangi P, Rimal RN, Edberg M, Munar W. "They Destroy the Reproductive System": Exploring the Belief that Modern Contraceptive Use Causes Infertility. Stud Fam Plann 2018; 49:345-365. [PMID: 30411794 PMCID: PMC6518934 DOI: 10.1111/sifp.12076] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A common reason for nonuse of modern contraceptives is concern about side effects and health complications. This article provides a detailed characterization of the belief that modern contraceptives cause infertility, and an examination of how this belief arises and spreads, and why it is so salient. We conducted focus group discussions and key informant interviews in three rural communities along Kenya's eastern coast, and identified the following themes: (1) the belief that using modern contraception at a young age or before childbirth can make women infertile is widespread; (2) according to this belief, the most commonly used methods in the community were linked to infertility; (3) when women observe other women who cannot get pregnant after using modern contraceptives, they attribute the infertility to the use of contraception; (4) within the communities, the primary goal of marriage is childbirth and thus community approval is rigidly tied to childbearing; and, therefore (5) the social consequences of infertility are devastating. These findings may help inform the design of programs to address this belief and reduce unmet need.
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Pill, patch or ring? A mixed methods analysis of provider counseling about combined hormonal contraception. Contraception 2018; 99:104-110. [PMID: 30227121 DOI: 10.1016/j.contraception.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 08/23/2018] [Accepted: 09/06/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In this study we aimed to investigate the content and process of contraceptive counseling surrounding combined hormonal contraceptive (CHC) methods (combined oral contraceptives, the ring, and the patch). STUDY DESIGN We performed a mixed methods analysis of data collected as part of the Patient-Provider Communication about Contraception study, in which reproductive age women and their providers were recruited at several San Francisco Bay Area clinics from 2009-2012. Participants completed pre- and post-visit surveys, and had their visits audio recorded and transcribed. We performed descriptive and bivariate analyses of the entire cohort to examine associations between demographic characteristics and pre-existing method preferences with method selection and counseling content, and coded transcripts of a subset of the sample for salient themes related to content and process of counseling about combined hormonal contraceptive methods using a directed content analysis approach. RESULTS The overall sample included 342 women, with 152 women (44%) having a preference for a specific CHC prior to their visit, 127 women (37%) had a preference for a non-CHC method, and 63 (18%) having no existing method preference. Of the women who reported preferring a CHC in their pre-visit survey, the majority (72%) chose that method. We found that women were inconsistently counseled about the range of CHC methods. For example, women who had no pre-visit method preference (52%) or who preferred the ring (54%) or the patch (73%) were more likely to receive comprehensive counseling about the three CHC methods than were women who preferred combined oral contraceptives (35%) or non-CHC methods (33%). Providers mentioned the patch the least often, and in qualitative analysis indicated discomfort with prescribing this method. Side effects and benefits of methods, as well as strategies to enhance successful use of the chosen method, were inconsistently discussed. In only 73% of visits in which a woman chose a CHC did the provider assess the patient's ability to use the chosen method correctly, and in 66% of all visits in which women chose a CHC method, providers discussed what to do if she was dissatisfied with the method. CONCLUSIONS Counseling about combined hormonal contraceptive methods often does not include information about all available methods, or comprehensive information about side effects, benefits, or logistics of use. As this counseling can impact patient's satisfaction with and continuation of their chosen method of contraception, future work should focus on designing interventions to improve providers' ability to meet patients' needs. IMPLICATIONS Short acting hormonal contraception is widely used, but counseling for these methods often neglects key features. Comprehensive counseling about all methods and their individual features can improve contraceptive selection and use.
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Nanda G, Rademacher K, Solomon M, Mercer S, Wawire J, Ngahu R. Experiences with the levonorgestrel-releasing intrauterine system in Kenya: qualitative interviews with users and their partners. EUR J CONTRACEP REPR 2018; 23:303-308. [PMID: 30198796 PMCID: PMC6191886 DOI: 10.1080/13625187.2018.1499892] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives: The levonorgestrel-releasing intrauterine system (LNG-IUS) is an underused contraceptive method in sub-Saharan Africa. A recent market assessment in Kenya found that if a more affordable version of the method were available it may increase demand and uptake of the method. We therefore aimed to examine attitudes and perceptions around the LNG-IUS and experiences of method use, including exploring attributes such as bleeding changes, contraceptive-related amenorrhoea and perceived non-contraceptive benefits. Methods: Qualitative interviews were conducted among 29 women who were current or recent users of the LNG-IUS, and among a subset (n = 9) of their husbands/partners. Results: Our findings indicate that women’s main reason for choosing the LNG-IUS for contraception was their perception that the method had fewer side effects compared with other contraceptive methods. Women had favourable attitudes towards using the LNG-IUS. Husbands were also very positive about their partner’s use of the method. Conclusion: Understanding the motivations and experiences of early adopters of the LNG-IUS can help inform the development of demand creation and communication strategies to influence uptake and continuation of the LNG-IUS both in Kenya and perhaps more broadly. Communication efforts that emphasise the positive attributes of the LNG-IUS could help promote wider use of the method, especially if new, more affordable product(s) become available.
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Affiliation(s)
- Geeta Nanda
- a Family Health International (FHI 360) , Washington , DC , USA
| | | | | | - Sarah Mercer
- d Austin, TX, USA, formerly with Family Health International (FHI 360) , Durham , NC , USA
| | - Jim Wawire
- e Family Health Options Kenya (FHOK) , Nairobi , Kenya
| | - Rose Ngahu
- e Family Health Options Kenya (FHOK) , Nairobi , Kenya
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Arteaga S, Caton L, Gomez AM. Planned, unplanned and in-between: the meaning and context of pregnancy planning for young people. Contraception 2018; 99:16-21. [PMID: 30120926 DOI: 10.1016/j.contraception.2018.08.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To understand how young people conceptualize planned, unplanned and "in-between" pregnancies. METHODS We conducted individual qualitative interviews with 50 young (ages 18-24) women and their male partners (n=100) in the San Francisco Bay Area to investigate prospective pregnancy intentions. In this analysis, we focused on participants' conceptualization of planned and unplanned pregnancies, as well as a status in between planned and unplanned. RESULTS Conceptualizations of pregnancy planning were influenced by personal experiences and life circumstances, including previous unplanned pregnancies. While many participants held up planned pregnancies as an ideal, the majority of participants (n=71) also felt that a status in between planned and unplanned pregnancy existed. Many described this in-between stage occurring when someone is "not not trying" or would find an unplanned pregnancy acceptable. Notably, a few participants mentioned that pregnancy planning was not possible because either it was uncommon among their peers or they felt a general lack of control over pregnancy. CONCLUSION Our analysis suggests that binary operationalization of pregnancies as "planned" and "unplanned" neglects the complexity of young people's lived experiences and perspectives. Contraceptive counseling approaches that allow patients the flexibility to express their considerations and feelings toward a potential future pregnancy could improve the quality of family planning visits and patient-provider interactions. IMPLICATIONS The traditional binary conceptualization of pregnancies as planned and unplanned may not holistically capture the diverse perspectives of young people. Increased understanding of the complexities in young people's conceptualizion of pregnancy planning can inform family planning care that is inclusive, relevant and supportive of a variety of perspectives.
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Affiliation(s)
- Stephanie Arteaga
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
| | - Lauren Caton
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
| | - Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA.
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Polis CB, Hussain R, Berry A. There might be blood: a scoping review on women's responses to contraceptive-induced menstrual bleeding changes. Reprod Health 2018; 15:114. [PMID: 29940996 PMCID: PMC6020216 DOI: 10.1186/s12978-018-0561-0] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/15/2018] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Concern about side effects and health issues are common reasons for contraceptive non-use or discontinuation. Contraceptive-induced menstrual bleeding changes (CIMBCs) are linked to these concerns. Research on women's responses to CIMBCs has not been mapped or summarized in a systematic scoping review. METHODS We conducted a systematic scoping review of data on women's responses to CIMBCs in peer-reviewed, English-language publications in the last 15 years. Investigator dyads abstracted information from relevant studies on pre-specified and emergent themes using a standardized form. We held an expert consultation to obtain critical input. We provide recommendations for researchers, contraceptive counselors, and product developers. RESULTS We identified 100 relevant studies. All world regions were represented (except Antarctica), including Africa (11%), the Americas (32%), Asia (7%), Europe (20%), and Oceania (6%). We summarize findings pertinent to five thematic areas: women's responses to contraceptive-induced non-standard bleeding patterns; CIMBCs influence on non-use, dissatisfaction or discontinuation; conceptual linkages between CIMBCs and health; women's responses to menstrual suppression; and other emergent themes. Women's preferences for non-monthly bleeding patterns ranged widely, though amenorrhea appears most acceptable in the Americas and Europe. Multiple studies reported CIMBCs as top reasons for contraceptive dissatisfaction and discontinuation; others suggested disruption of regular bleeding patterns was associated with non-use. CIMBCs in some contexts were perceived as linked with a wide range of health concerns; e.g., some women perceived amenorrhea to cause a buildup of "dirty" or "blocked" blood, in turn perceived as causing blood clots, fibroids, emotional disturbances, weight gain, infertility, or death. Multiple studies addressed how CIMBCs (or menstruation) impacted daily activities, including participation in domestic, work, school, sports, or religious life; sexual or emotional relationships; and other domains. CONCLUSIONS Substantial variability exists around how women respond to CIMBCs; these responses are shaped by individual and social influences. Despite variation in responses across contexts and sub-populations, CIMBCs can impact multiple aspects of women's lives. Women's responses to CIMBCs should be recognized as a key issue in contraceptive research, counseling, and product development, but may be underappreciated, despite likely - and potentially substantial - impacts on contraceptive discontinuation and unmet need for modern contraception.
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Affiliation(s)
- Chelsea B. Polis
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038 USA
| | - Rubina Hussain
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038 USA
| | - Amanda Berry
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038 USA
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Gilmore K, Ojanen-Goldsmith A, Callegari LS, Godfrey EM. The first 6 months: developing a user-informed anticipatory counselling video about the levonorgestrel intrauterine system. BMJ SEXUAL & REPRODUCTIVE HEALTH 2018; 44:bmjsrh-2018-200055. [PMID: 29934403 DOI: 10.1136/bmjsrh-2018-200055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/19/2018] [Accepted: 05/23/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The levonorgestrel intrauterine system (LNG-IUS) is a contraceptive method that can cause irregular bleeding and cramping during the first 6 months of use. Expected side effects are common reasons given for LNG-IUS device discontinuation within 12 months of use. Anticipatory counselling regarding expected LNG-IUS side effects may reduce method discontinuation and improve patient satisfaction. Educational videos could improve anticipatory counselling for LNG-IUS users; however, none have been developed. This article describes the process of developing an anticipatory counselling video with input from women in the first 6 months of LNG-IUS use and from family planning (FP) experts. METHODS We used a participatory, iterative process to develop an anticipatory counselling video about the first 6 months of LNG-IUS use. We developed a preliminary draft using evidence from the published literature. We sought feedback from 11 FP experts and 49 LNG-IUS users to revise the script before creating the final video. RESULTS FP experts suggested balancing negative with positive information and using colloquial language. LNG-IUS users requested more detailed information on the LNG-IUS mechanism of action and expected side effects in the form of statistics, infographic animations, testimonials from LNG-IUS users, and technical as opposed to colloquial language. The final video is 6 min in length and features seven LNG-IUS users, three physicians, and infographic animations. CONCLUSION Including input from FP experts and LNG-IUS users in the development process resulted in a 6-min anticipatory counselling video that will be piloted among patients on the day of their LNG-IUS insertion.
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Affiliation(s)
- Kelly Gilmore
- Departments of Obstetrics and Gynecology and Health Services, University of Washington, Seattle, Washington, USA
| | | | - Lisa S Callegari
- Departments of Obstetrics and Gynecology and Health Services, University of Washington, Seattle, Washington, USA
| | - Emily M Godfrey
- Departments of Family Medicine and Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
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Development of an intervention delivered by mobile phone aimed at decreasing unintended pregnancy among young people in three lower middle income countries. BMC Public Health 2018; 18:576. [PMID: 29716571 PMCID: PMC5930955 DOI: 10.1186/s12889-018-5477-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 04/18/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Unintended pregnancies can result in poorer health outcomes for women, children and families. Young people in low and middle income countries are at particular risk of unintended pregnancies and could benefit from innovative contraceptive interventions. There is growing evidence that interventions delivered by mobile phone can be effective in improving a range of health behaviours. This paper describes the development of a contraceptive behavioural intervention delivered by mobile phone for young people in Tajikistan, Bolivia and Palestine, where unmet need for contraception is high among this group. METHODS Guided by Intervention Mapping, the following steps contributed to the development of the interventions: (1) needs assessment; (2) specifying behavioural change to result from the intervention; (3) selecting behaviour change methods to include in the intervention; (4) producing and refining the intervention content. RESULTS The results of the needs assessment produced similar interventions across the countries. The interventions consist of short daily messages delivered over 4 months (delivered by text messaging in Palestine and mobile phone application instant messages in Bolivia and Tajikistan). The messages provide information about contraception, target attitudes that are barriers to contraceptive uptake and support young people in feeling that they can influence their reproductive health. The interventions each contain the same ten behaviour change methods, adapted for delivery by mobile phone. CONCLUSIONS The development resulted in a well-specified, theory-based intervention, tailored to each country. It is feasible to develop an intervention delivered by mobile phone for young people in resource-limited settings.
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Okour AM, Saadeh RA, Zaqoul M. Evaluation of Family Planning Counselling in North Jordan. Sultan Qaboos Univ Med J 2018; 17:e436-e443. [PMID: 29372086 DOI: 10.18295/squmj.2017.17.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/14/2017] [Accepted: 09/21/2017] [Indexed: 11/16/2022] Open
Abstract
Objectives Counselling plays a key role in enhancing reproductive services, providing contraception-related information and supporting long-term family planning for women of childbearing age. This study aimed to evaluate family planning counselling sessions in selected governmental and private clinics in northern Jordan. Methods This cross-sectional study was conducted between January and June 2016 in Irbid, Jordan. A total of 200 women attending two private clinics affiliated with the Jordanian Association for Family Planning and Protection (JAFPP) and six governmental clinics were invited to participate in the study. Counselling sessions were attended by an independent observer and evaluated with regards to their compliance with the standard Greet, Ask, Tell, Help, Explain, Return (GATHER) framework. Results A total of 198 women participated in the study (response rate: 99.0%), including 80 women (40.4%) from JAFPP clinics and 118 (59.6%) from governmental clinics. In total, 42.9% of the counselling sessions were deemed adequate, with providers applying 80% or more of the GATHER framework, while 26.8% of the sessions were deemed semi-adequate and 30.3% were considered inadequate. Counselling services provided in the governmental clinics were significantly less adequate than those provided in JAFPP clinics (P <0.001). Conclusion The quality of counselling services in governmental family planning centres in Jordan needs to be improved to ensure that women receive the highest possible level of care. Healthcare policymakers should therefore focus on developing and supporting effective family planning counselling services in northern Jordan.
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Affiliation(s)
- Abdulhakeem M Okour
- Department of Public Health & Community Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Rami A Saadeh
- Department of Public Health & Community Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Mona Zaqoul
- Department of Public Health & Community Medicine, Jordan University of Science & Technology, Irbid, Jordan
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Biset N, Lelubre M, Senterre C, Amighi K, Bugnon O, Schneider MP, De Vriese C. Assessment of medication adherence and responsible use of isotretinoin and contraception through Belgian community pharmacies by using pharmacy refill data. Patient Prefer Adherence 2018; 12:153-161. [PMID: 29403267 PMCID: PMC5783016 DOI: 10.2147/ppa.s149355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The aims of the study were to evaluate medication adherence and the influencing factors for isotretinoin and contraception (oral, patches, and rings) and to evaluate the concomitant use of contraception and isotretinoin. METHODS Reimbursed prescription data from January 2012 to August 2015 of all patients in Belgium were received from Pharmanet-National Institute for Health and Disability Insurance. Medication adherence was measured according to the medication possession ratio. The influence of gender and age was analyzed using the Mann-Whitney test and the Spearman coefficient correlation. The independence between adherence to contraception and adherence to isotretinoin was analyzed using the Pearson chi-square test of independence. Persistence was defined as the number of days between initiation and presumed end of treatment. The Kaplan-Meier method was used to plot the medication persistence curves, and the log-rank test was used to compare the curves. The concomitant use of contraception and isotretinoin was analyzed using descriptive statistics. RESULTS The medication possession ratio was ≥0.8 for 46.1% of patients receiving isotretinoin and for 74.0% of women using contraception. For isotretinoin, this percentage decreased as the number of attempts increased (29.8% for the second attempt and 19.8% for more than two attempts). Men seemed more adherent than women, and a weak negative correlation between adherence and age was observed. The adherence data of isotretinoin and contraception were independent. The median persistence for isotretinoin treatment was 139 days (interquartile range 71-209) and was higher for men. Among women between 12 and 21 years old taking isotretinoin, 63.8% received at least one contraceptive prescription. However, 15.7% of women taking isotretinoin adhered to the use of contraception 1 month before, during, and 1 month after treatment. CONCLUSION Medication adherence to isotretinoin and contraception and compliance with the isotretinoin safety recommendation could be improved. Health service interventions, using pharmacy refill data, should be delivered to ensure patient safety and strict adherence to contraception when under isotretinoin treatment.
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Affiliation(s)
- Natacha Biset
- Department of Pharmacotherapy and Pharmaceutics, Faculté de Pharmacie, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Mélanie Lelubre
- Department of Pharmacotherapy and Pharmaceutics, Faculté de Pharmacie, Université libre de Bruxelles (ULB), Brussels, Belgium
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Christelle Senterre
- Research Center of Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Karim Amighi
- Department of Pharmacotherapy and Pharmaceutics, Faculté de Pharmacie, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Olivier Bugnon
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Marie P Schneider
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Carine De Vriese
- Department of Pharmacotherapy and Pharmaceutics, Faculté de Pharmacie, Université libre de Bruxelles (ULB), Brussels, Belgium
- Correspondence: Carine De Vriese, Université libre de Bruxelles (ULB), Campus de la Plaine, CP-207 – Bat BC, Boulevard du Triomphe, Accès 2, B-1050 Brussels, Belgium, Tel +322 650 53 20, Fax +322 650 52 69, Email
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Casey SE, Cannon A, Mushagalusa Balikubirhi B, Muyisa JB, Amsalu R, Tsolka M. Twelve-month contraceptive continuation among women initiating short- and long-acting reversible contraceptives in North Kivu, Democratic Republic of the Congo. PLoS One 2017; 12:e0182744. [PMID: 28886016 PMCID: PMC5590733 DOI: 10.1371/journal.pone.0182744] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 07/23/2017] [Indexed: 11/18/2022] Open
Abstract
Context Despite the inclusion of sexual and reproductive health (SRH) services in the minimum standards of health care in humanitarian settings, access to SRH services, and especially to contraception, is often compromised in war. Very little is known about continuation and switching of contraceptive methods in these settings. An evaluation of a contraceptive services program in North Kivu, Democratic Republic of the Congo (DRC) was conducted to measure 12-month contraceptive continuation by type of contraceptive method (short-acting or long-acting). Methods A stratified systematic sample of women who initiated a contraceptive method 12–18 months prior to data collection was selected retrospectively from facility registers. A total of 548 women was interviewed about their contraceptive use: 304 who began a short-acting method (pills, injectables) and 244 who began a long-acting method (intra-uterine devices, implants). Key characteristics of short-acting method versus long-acting method acceptors were compared using chi-square statistics for categorical data and t-tests for continuous data. Unadjusted and adjusted Cox proportional hazard ratios were estimated to assess factors associated with discontinuation. Results At 12 months, 81.6% women reported using their baseline contraceptive method continuously, with more long-acting than short-acting contraceptive acceptors (86.1% versus 78.0%, p = .02) continuing contraceptive use. Use of a short-acting method (Hazard ratio (HR) 1.74 [95%CI 1.13–2.67]) and desiring a child within two years (HR 2.58 [95%CI 1.45–4.54]) were associated with discontinuation within the first 12 months of use. The vast majority (88.3%) of women reported no prior contraceptive use. Conclusion This is the first study of contraceptive continuation in a humanitarian setting. The high percentages of women continuing contraceptive use found here demonstrates that women will choose to initiate and continue use of their desired contraceptive method, even in a difficult, unstable and low contraceptive prevalence setting like North Kivu.
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Affiliation(s)
- Sara E. Casey
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- * E-mail:
| | - Amy Cannon
- Save the Children USA, Washington DC, United States of America
| | | | | | - Ribka Amsalu
- Save the Children USA, Washington DC, United States of America
| | - Maria Tsolka
- Save the Children USA, Washington DC, United States of America
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Badawy SM, Kuhns LM. Texting and Mobile Phone App Interventions for Improving Adherence to Preventive Behavior in Adolescents: A Systematic Review. JMIR Mhealth Uhealth 2017; 5:e50. [PMID: 28428157 PMCID: PMC5415660 DOI: 10.2196/mhealth.6837] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/16/2017] [Accepted: 03/05/2017] [Indexed: 11/23/2022] Open
Abstract
Background Many preventable behaviors contribute to adolescent mortality and morbidity. Non-adherence to preventive measures represents a challenge and has been associated with worse health outcomes in this population. The widespread use of electronic communication technologies by adolescents, particularly the use of text messaging (short message service, SMS) and mobile phones, presents new opportunities to intervene on risk and preventive risk behavior, but little is known about their efficacy. Objective This study aimed to systematically evaluate evidence for the efficacy of text messaging and mobile phone app interventions to improve adherence to preventive behavior among adolescents and describe intervention approaches to inform intervention development. Methods This review covers literature published between 1995 and 2015. Searches included PubMed, Embase, CENTRAL, PsycINFO, CINAHL, INSPEC, Web of Science, Google Scholar, and additional databases. The search strategy sought articles on text messaging and mobile phone apps combined with adherence or compliance, and adolescents and youth. An additional hand search of related themes in the Journal of Medical Internet Research was also conducted. Two reviewers independently screened titles and abstracts, assessed full-text articles, and extracted data from articles that met inclusion criteria. Included studies reflect original research—experimental or preexperimental designs with text messaging or mobile phone app interventions—targeting adherence to preventive behavior among adolescents (12-24 years old). The preferred reporting items of systematic reviews and meta-analyses (PRISMA) guidelines were followed for reporting results, and findings were critically appraised against the Oxford Centre for Evidence-based Medicine criteria. Results Of 1454 records, 19 met inclusion criteria, including text messaging (n=15) and mobile phone apps (n=4). Studies targeted clinic attendance, contraceptive use, oral health, physical activity and weight management, sun protection, human papillomavirus (HPV) vaccination, smoking cessation, and sexual health. Most studies were performed in the United States (47%, 9/19), included younger adolescents (63%, 12/19), and had sample size <100 (63%, 12/19). Although most studies were randomized controlled trials (RCTs; 58%, 11/19), only 5 followed an intent-to-treat analysis. Only 6 of 19 studies (32%) incorporated a theoretical framework in their design. Most studies reported good feasibility with high acceptability and satisfaction. About half of the included studies (42%, 8/19) demonstrated significant improvement in preventive behavior with moderate standardized mean differences. As early efforts in this field to establish feasibility and initial efficacy, most studies were low to moderate in quality. Studies varied in sample size and methods of preventive behavior adherence or outcome assessment, which prohibited performing a meta-analysis. Conclusions Despite the promising feasibility and acceptability of text messaging and mobile phone apps in improving preventive behavior among adolescents, overall findings were modest in terms of efficacy. Further research evaluating the efficacy, effectiveness, and cost-effectiveness of these intervention approaches in promoting preventive behavior among adolescents is needed.
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Affiliation(s)
- Sherif M Badawy
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Division of Hematology, Oncology, and Stem Cell Transplant, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Pediatrics, Division of Hematology/Oncology, Zagazig University Faculty of Medicine, Zagazig, Egypt
| | - Lisa M Kuhns
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Division of Adolescent Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Rominski SD, Sk Morhe E, Maya E, Manu A, Dalton VK. Comparing Women's Contraceptive Preferences With Their Choices in 5 Urban Family Planning Clinics in Ghana. GLOBAL HEALTH: SCIENCE AND PRACTICE 2017; 5:65-74. [PMID: 28179370 PMCID: PMC5493451 DOI: 10.9745/ghsp-d-16-00281] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/29/2016] [Indexed: 11/26/2022]
Abstract
Women's method choice largely matched their stated desired duration of effectiveness but not their desires to avoid certain side effects. While most women reported they were counseled about side effects, many fewer reported being specifically counseled about common menstrual side effects with their chosen method, including side effects the women said would cause them to stop using the method. Background: Concern about contraceptive side effects is a common reason reported by women for not using contraception or discontinuing use. We sought to characterize women's preferences related to method characteristics and side effects and to examine whether their adopted method was consistent with their stated preferences. Methods: Between June 1, 2015, and August 31, 2015, we surveyed women attending 5 urban family planning clinics in Kumasi and Accra, Ghana, before and after their counseling sessions. All women attending these clinics were approached to gauge their interest and eligibility for inclusion. Before counseling, women were asked about desired method characteristics and bothersome and intolerable side effects. After counseling, women were asked about method adoption and the counseling received about side effects. We then used crosstabs to compare the side effects women were counseled to expect, as well as those they reported would be intolerable, with their adopted methods to determine consistency between women's preferences and choices. Results: In total, 414 and 411 women completed the pre- and post-counseling surveys, respectively. The analysis sample consisted of 336 participants who adopted a method and were matched between the 2 surveys. The 3 most commonly chosen methods were the implant (n=135, 40.1%), injectables (n=109, 32.4%), and the intrauterine device (IUD) (n=52, 13.4%). The large majority (at least 87%) of method adopters chose a method that was well matched with their desired duration of effectiveness. Consistency between women's expressed intolerable side effects and their chosen methods was substantially lower: at least 70% of women choosing the implant, IUD, or injectables had stated they would stop using a method if they experienced those side effects that are in fact common with their respectively chosen methods. While 65.0% of those who adopted a method reported they were counseled to expect side effects, substantially less were counseled to expect the side effects common with use of their adopted method. Conclusion: Women's choice of contraceptive methods generally matched their stated preferences related to desired duration of effectiveness but not to potential side effects, and most women reported they were not counseled to expect the side effects common with use of their chosen method. Providers need to address potential side effects during counseling both to ensure women choose methods that will be a good fit with their desires and to reassure them that commonly experienced side effects are not harmful.
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Okigbo CC, Speizer IS, Domino ME, Curtis SL. A Multilevel Logit Estimation of Factors Associated With Modern Contraception in Urban Nigeria. WORLD MEDICAL & HEALTH POLICY 2017; 9:65-88. [PMID: 31428512 DOI: 10.1002/wmh3.215] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Chinelo C Okigbo
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, USA.,Measurement, Learning & Evaluation Project, Carolina Population Center, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Ilene S Speizer
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, USA.,Measurement, Learning & Evaluation Project, Carolina Population Center, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Marisa E Domino
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Sian L Curtis
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, USA
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Koo HP, Wilson EK, Minnis AM. A Computerized Family Planning Counseling Aid: A Pilot Study Evaluation of Smart Choices. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2017; 49:45-53. [PMID: 28222240 DOI: 10.1363/psrh.12016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 10/27/2016] [Accepted: 11/04/2016] [Indexed: 05/05/2023]
Abstract
CONTEXT Resource constraints may make it challenging for family planning clinics to provide comprehensive contraceptive counseling; technological tools that help providers follow recommended practices without straining resources merit evaluation. METHODS A pilot study using a two-group, posttest-only experimental design evaluated Smart Choices, a computer-based tool designed to help providers offer more patient-centered counseling and enable patients to participate proactively in the counseling session. In two North Carolina family planning clinics, 214 women received usual counseling in March-May 2013, and 126 women used Smart Choices in May-July 2013. Exit interviews provided data for the evaluation. Multivariate Poisson and multinomial logistic regression analyses were performed to examine group differences in counseling outcomes. RESULTS Three of 12 hypotheses tested were supported: Compared with controls, women in the intervention group knew more contraceptive methods (adjusted mean, 11.1 vs. 10.7); discussed more topics related to sexual health during counseling (1.2 vs. 0.9 among those reporting any discussion); and rated counseling as more patient-centered, an indication of how well they felt providers understood their family planning circumstances and ideas (3.9 vs. 3.7 on a scale of 1-4). Contrary to another hypothesis, controls were more likely than women in the intervention group to choose IUDs and implants. CONCLUSIONS Computerized counseling aids like Smart Choices are in an early stage of development. Future research is warranted to develop tools that lead to more productive and individualized clinic visits and, ultimately, to more effective contraceptive use and reduced levels of unintended pregnancy.
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Affiliation(s)
- Helen P Koo
- senior research demographer and consultant, RTI International, Research Triangle Park, NC
| | - Ellen K Wilson
- research health scientist, RTI International, Research Triangle Park, NC
| | - Alexandra M Minnis
- senior research epidemiologist with the Women's Global Health Imperative, RTI International, San Francisco
- associate professor, School of Public Health, University of California, Berkeley
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Machiyama K, Casterline JB, Mumah JN, Huda FA, Obare F, Odwe G, Kabiru CW, Yeasmin S, Cleland J. Reasons for unmet need for family planning, with attention to the measurement of fertility preferences: protocol for a multi-site cohort study. Reprod Health 2017; 14:23. [PMID: 28183308 PMCID: PMC5299702 DOI: 10.1186/s12978-016-0268-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/20/2016] [Indexed: 11/14/2022] Open
Abstract
Background Unmet need for family planning points to the gap between women’s reproductive desire to avoid pregnancy and contraceptive behaviour. An estimated 222 million women in low- and middle-income countries have unmet need for modern contraception. Despite its prevalence, there has been little rigorous research during the past fifteen years on reasons for this widespread failure to implement childbearing desires in contraceptive practice. There is demographic survey data on women’s self-reported reasons for non-use, but these data provide limited insight on the full set of possible obstacles to use, and one may doubt the meaningfulness of explanations provided by non-users alone. To rectify this evidence gap, this study will gather extensive information on women’s perceptions of contraception (generic and method-specific) and their past contraceptive experience, and it will allow for more complexity in fertility preferences than is standard in demographic surveys. Methods A multi-site cohort study will be conducted in urban Kenya, rural Kenya, and rural Bangladesh. In each setting trained fieldworkers will recruit and interview 2600 women, with participants re-interviewed at 12 and 18 months. Data will be collected using a questionnaire whose development was informed by a review of existing literature and instruments from past studies in both developed and developing countries. Dozens of experts in the field were consulted as the instrument was developed. The questionnaire has three main components: a sub-set of Demographic and Health Survey items measuring socio-demographic characteristics, reproductive history, and sexual activity; additional questions on prospective and retrospective fertility preferences designed to capture ambivalence and uncertainty; and two large blocks of items on (i) generic concerns about contraception and (ii) method-specific attributes. The method-specific items encompass eight modern and traditional methods. Discussion Policy and programmes intended to reduce unmet need for contraception in developing countries should be informed by clear understanding of the causes of this phenomenon to better reflect the population needs and to more effectively target planning and investments. To this end, this study will field an innovative instrument in Kenya and Bangladesh. The information to be collected will support a rigorous assessment of reasons for unmet need for family planning.
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Affiliation(s)
- Kazuyo Machiyama
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - John B Casterline
- Institute for Population Research, Ohio State University, Columbus, USA
| | - Joyce N Mumah
- African Population and Health Research Center, Nairobi, Kenya
| | | | | | | | | | | | - John Cleland
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Cropsey KL, Clark CB, Stevens EN, Schiavon S, Lahti AC, Hendricks PS. Predictors of medication adherence and smoking cessation among smokers under community corrections supervision. Addict Behav 2017; 65:111-117. [PMID: 27816035 PMCID: PMC5907501 DOI: 10.1016/j.addbeh.2016.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 10/04/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Individuals in the U.S. criminal justice system now represent over 12% of all current U.S. smokers. With smoking banned in most U.S. jails and prisons, the cessation focus for this population has shifted to individuals who are under community correction supervision (e.g., probation, parole). The aim of this study was to examine predictors of successful smoking cessation among criminal justice individuals supervised in the community. METHODS Five hundred participants under community corrections supervision were randomized to receive either four sessions of smoking cessation counseling or no counseling in conjunction with 12weeks of bupropion treatment plus brief physician advice to quit. Logistic regression analyses examined associations of smoking variables with medication adherence and successful abstinence. Mediation analysis evaluated the indirect effects of medication adherence on smoking abstinence. RESULTS The strongest associate of medication adherence was previous use of bupropion, while the strongest associate of smoking abstinence was medication adherence. Mediation analysis indicated that previous use of bupropion indirectly increased cessation rates through the pathway of increased medication adherence. CONCLUSIONS These results highlight the importance of medication adherence for smoking cessation among community corrections smokers. Providing exposure to medication may be a promising intervention to increase medication adherence and subsequent cessation rates in this population.
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Affiliation(s)
- Karen L Cropsey
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Sparks Center 1016, 1720 2nd Ave. South, Birmingham, AL 35294, USA.
| | - C Brendan Clark
- Wichita State University, Department of Psychology, Box 34, Wichita, Kansas 67260-0034, USA.
| | - Erin N Stevens
- Auburn Psychology Group, LLC. 861-D North Dean Road, Auburn, AL 36830, USA.
| | - Samantha Schiavon
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Sparks Center 1016, 1720 2nd Ave. South, Birmingham, AL 35294, USA.
| | - Adrienne C Lahti
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Sparks Center 1016, 1720 2nd Ave. South, Birmingham, AL 35294, USA.
| | - Peter S Hendricks
- University of Alabama at Birmingham, School of Public Health, Department of Health Behavior, 227L Ryals Public Health Building, 1665 University Blvd., Birmingham, AL 35294, USA.
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Bastianelli C, Farris M, Bruno Vecchio RC, Rosato E, Guida M, Benagiano G. An observational study of adherence to combined oral contraceptive regimens. Gynecol Endocrinol 2017; 33:168-172. [PMID: 27809677 DOI: 10.1080/09513590.2016.1240776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To analyze adherence to an oral contraceptive (OC) regimen and correlate results to participants' socio-demographic and behavioral characteristics. METHODS Women were prospectively enrolled and followed for 6 months. At enrollment, subjects were given a card for recording daily pill intake; its completion was checked at 6 months when women completed a self-administered questionnaire. RESULTS Out of 755 eligible subjects, 704 agreed to participate; 402 women completed 6 months of recording of use of an OC and properly filled the questionnaire. Good adherence was reported by 64% of participants; 20.9% missed one pill and 14.9% missed more than one pill. Mean number of missed pills per subject was 0.59 and mean number of pills delayed for less than 24 h was 1.18. Best adherence to a COC regimen was associated with evening time intake (p = 0.0019). No statistically significant associations of adherence with socio-demographic characteristics were found. Age was only marginally associated with having missed at least one pill. CONCLUSION In the present study, a lower number of missed pills were observed than previously reported, but the proportion of missed pills was similar. No association with specific subject characteristics that could serve as markers of increased risk of nonadherence was found.
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Affiliation(s)
- Carlo Bastianelli
- a Department of Gynecological and Obstetrical Sciences and Urological Sciences , Sapienza University of Rome , Rome , Italy
| | - Manuela Farris
- a Department of Gynecological and Obstetrical Sciences and Urological Sciences , Sapienza University of Rome , Rome , Italy
- b Italian Association for Demographic Education, AIED , Rome , Italy , and
| | - Roberta Costanza Bruno Vecchio
- a Department of Gynecological and Obstetrical Sciences and Urological Sciences , Sapienza University of Rome , Rome , Italy
| | - Elena Rosato
- a Department of Gynecological and Obstetrical Sciences and Urological Sciences , Sapienza University of Rome , Rome , Italy
| | - Maurizio Guida
- c Department of Medicine and Surgery , University of Salerno , Salerno , Italy
| | - Giuseppe Benagiano
- a Department of Gynecological and Obstetrical Sciences and Urological Sciences , Sapienza University of Rome , Rome , Italy
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Abstract
BACKGROUND The explicit use of theory in research helps expand the knowledge base. Theories and models have been used extensively in HIV-prevention research and in interventions for preventing sexually transmitted infections (STIs). The health behavior field uses many theories or models of change. However, many educational interventions addressing contraception have no explicit theoretical base. OBJECTIVES To review randomized controlled trials (RCTs) that tested a theoretical approach to inform contraceptive choice and encourage or improve contraceptive use. SEARCH METHODS To 1 November 2016, we searched for trials that tested a theory-based intervention for improving contraceptive use in PubMed, CENTRAL, POPLINE, Web of Science, ClinicalTrials.gov, and ICTRP. For the initial review, we wrote to investigators to find other trials. SELECTION CRITERIA Included trials tested a theory-based intervention for improving contraceptive use. Interventions addressed the use of one or more methods for contraception. The reports provided evidence that the intervention was based on a specific theory or model. The primary outcomes were pregnancy and contraceptive choice or use. DATA COLLECTION AND ANALYSIS We assessed titles and abstracts identified during the searches. One author extracted and entered the data into Review Manager; a second author verified accuracy. We examined studies for methodological quality.For unadjusted dichotomous outcomes, we calculated the Mantel-Haenszel odds ratio (OR) with 95% confidence interval (CI). Cluster randomized trials used various methods of accounting for the clustering, such as multilevel modeling. Most reports did not provide information to calculate the effective sample size. Therefore, we presented the results as reported by the investigators. We did not conduct meta-analysis due to varied interventions and outcome measures. MAIN RESULTS We included 10 new trials for a total of 25. Five were conducted outside the USA. Fifteen randomly assigned individuals and 10 randomized clusters. This section focuses on nine trials with high or moderate quality evidence and an intervention effect. Five based on social cognitive theory addressed preventing adolescent pregnancy and were one to two years long. The comparison was usual care or education. Adolescent mothers with a home-based curriculum had fewer second births in two years (OR 0.41, 95% CI 0.17 to 1.00). Twelve months after a school-based curriculum, the intervention group was more likely to report using an effective contraceptive method (adjusted OR 1.76 ± standard error (SE) 0.29) and using condoms during last intercourse (adjusted OR 1.68 ± SE 0.25). In alternative schools, after five months the intervention group reported more condom use during last intercourse (reported adjusted OR 2.12, 95% CI 1.24 to 3.56). After a school-based risk-reduction program, at three months the intervention group was less likely to report no condom use at last intercourse (adjusted OR 0.67, 95% CI 0.47 to 0.96). The risk avoidance group (abstinence-focused) was less likely to do so at 15 months (OR 0.61, 95% CI 0.45 to 0.85). At 24 months after a case management and peer-leadership program, the intervention group reported more consistent use of hormonal contraceptives (adjusted relative risk (RR) 1.30, 95% CI 1.06 to 1.58), condoms (RR 1.57, 95% CI 1.28 to 1.94), and dual methods (RR 1.36, 95% CI 1.01 to 1.85).Four of the nine trials used motivational interviewing (MI). In three studies, the comparison group received handouts. The MI group more often reported effective contraception use at nine months (OR 2.04, 95% CI 1.47 to 2.83). In two studies, the MI group was less likely to report using ineffective contraception at three months (OR 0.31, 95% CI 0.12 to 0.77) and four months (OR 0.56, 95% CI 0.31 to 0.98), respectively. In the fourth trial, the MI group was more likely than a group with non-standard counseling to initiate long-acting reversible contraception (LARC) by one month (OR 3.99, 95% CI 1.36 to 11.68) and to report using LARC at three months (OR 3.38, 95% CI 1.06 to 10.71). AUTHORS' CONCLUSIONS The overall quality of evidence was moderate. Trials based on social cognitive theory focused on adolescents and provided multiple sessions. Those using motivational interviewing had a wider age range but specific populations. Sites with low resources need effective interventions adapted for their settings and their typical clients. Reports could be clearer about how the theory was used to design and implement the intervention.
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Affiliation(s)
- Laureen M Lopez
- FHI 360Clinical and Epidemiological Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Thomas W Grey
- FHI 360Social and Behavioral Health Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Mario Chen
- FHI 360Biostatistics359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Elizabeth E. Tolley
- FHI 360Social and Behavioral Health Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Laurie L Stockton
- University of North CarolinaSchool of Media and JournalismCarroll Hall 386Chapel HillNorth CarolinaUSA27599‐3365
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Abstract
Adolescents have high rates of unintended pregnancy and face unique reproductive health challenges. Providing confidential contraceptive services to adolescents is important in reducing the rate of unintended pregnancy. Long-acting contraception such as the intrauterine device and contraceptive implant are recommended as first-line contraceptives for adolescents because they are highly effective with few side effects. The use of barrier methods to prevent sexually transmitted infections should be encouraged. Adolescents have limited knowledge of reproductive health and contraceptive options, and their sources of information are often unreliable. Access to contraception is available through a variety of resources that continue to expand.
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Affiliation(s)
- Shandhini Raidoo
- Department of Obstetrics, Gynecology, and Women's Health, Kapiolani Medical Center for Women and Children, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Suite 824, Honolulu, HI 96826, USA.
| | - Bliss Kaneshiro
- Department of Obstetrics, Gynecology, and Women's Health, Kapiolani Medical Center for Women and Children, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Suite 824, Honolulu, HI 96826, USA
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Lopez LM, Grey TW, Chen M, Denison J, Stuart G. Behavioral interventions for improving contraceptive use among women living with HIV. Cochrane Database Syst Rev 2016; 2016:CD010243. [PMID: 27505053 PMCID: PMC7092487 DOI: 10.1002/14651858.cd010243.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Contraception services can help meet the family planning goals of women living with HIV as well as prevent mother-to-child transmission. Due to antiretroviral therapy, survival has improved for people living with HIV, and more HIV-positive women may desire to have a child or another child. Behavioral interventions, involving counseling or education, can help women choose and use an appropriate contraceptive method. OBJECTIVES We systematically reviewed studies of behavioral interventions for HIV-positive women intended to inform contraceptive choice, encourage contraceptive use, or promote adherence to a contraceptive regimen. SEARCH METHODS Until 2 August 2016, we searched MEDLINE, CENTRAL, Web of Science, POPLINE, ClinicalTrials.gov and ICTRP. For the initial review, we examined reference lists and unpublished project reports, and we contacted investigators in the field. SELECTION CRITERIA Studies evaluated a behavioral intervention for improving contraceptive use for family planning (FP). The comparison could have been another behavioral intervention, usual care, or no intervention. We also considered studies that compared HIV-positive versus HIV-negative women. We included non-randomized studies as well as randomized controlled trials (RCTs).Primary outcomes were pregnancy and contraception use, e.g. uptake of a new method or improved use or continuation of current method. Secondary outcomes were knowledge of contraceptive effectiveness and attitude about contraception or a specific contraceptive method. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data. One entered the data into RevMan and a second verified accuracy. We evaluated RCTs according to recommended principles. For non-randomized studies, we examined the quality of evidence using the Newcastle-Ottawa Quality Assessment Scale. Given the need to control for confounding factors in non-randomized studies, we used adjusted estimates from the models when available. Where we did not have adjusted analyses, we calculated the odds ratio (OR) with 95% confidence interval (CI). Due to varied study designs and interventions, we did not conduct meta-analysis. MAIN RESULTS With three new reports, 10 studies from seven African countries met our eligibility criteria. Eight non-randomized studies included 8980 participants. Two cluster RCTs had 7136 participants across 36 sites. Three studies compared a special FP intervention versus usual care, three examined FP services integrated with HIV services, and four compared outcomes for HIV-positive and HIV-negative women.In four studies with high or moderate quality evidence, the special intervention was associated with contraceptive use or pregnancy. A study from Nigeria compared enhanced versus basic FP services. All sites had integrated FP and HIV services. Women with enhanced services were more likely to use a modern contraceptive method versus women with basic services (OR 2.48, 95% CI 1.31 to 4.72). A cluster RCT conducted in Kenya compared integrated FP and HIV services versus standard referral to a separate FP clinic. Women with integrated services were more likely to use more effective contraception (adjusted OR 1.81, 95% CI 1.24 to 2.63). Another cluster RCT compared an HIV prevention and FP intervention versus usual care in Kenya, Namibia, and Tanzania. Women at the special intervention sites in Tanzania were more likely to use highly effective contraception (adjusted OR 2.25, 95% CI 1.24 to 4.10). They were less likely to report unprotected sex (no condom use) at last intercourse (adjusted OR 0.23, 95% CI 0.14 to 0.40). Across the three countries, women at the special intervention sites were less likely to report any unprotected sex in the past two weeks (adjusted OR 0.56, 95% CI 0.32 to 0.99). A study in Côte d'Ivoire integrated HIV and FP services. HIV-positive women had a lower incidence of undesired pregnancy, but not overall pregnancy, compared with HIV-negative women (1.07 versus 2.38; reported P = 0.023). AUTHORS' CONCLUSIONS The studies since 2009 focused on using modern or more effective methods of contraception. In those later reports, training on FP methods and counseling was more common, which may strengthen the intervention and improve the ability to meet clients' needs. The quality of evidence was moderate from the more recent studies and low for those from the 1990s.Comparative research involving contraceptive counseling for HIV-positive women is limited. The FP field needs better ways to help women choose an appropriate contraceptive and continue using that method. Improved counseling methods are especially needed for limited resource settings, such as clinics focusing on people living with HIV.
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Affiliation(s)
- Laureen M Lopez
- FHI 360Clinical and Epidemiological Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Thomas W Grey
- FHI 360Social and Behavioral Health Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Mario Chen
- FHI 360Biostatistics359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Julie Denison
- Johns Hopkins University Bloomberg School of Public HealthInternational HealthBaltimoreMarylandUSA
| | - Gretchen Stuart
- University of North Carolina School of MedicineDepartment of Obstetrics and Gynecology3031 Old Clinic Building CB#7570Chapel HillNorth CarolinaUSA27599‐7570
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Mayer JE, Fontelo P. Meta-analysis on the effect of text message reminders for HIV-related compliance. AIDS Care 2016; 29:409-417. [PMID: 27477580 DOI: 10.1080/09540121.2016.1214674] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
For the treatment of HIV, compliance in regard to appointment attendance and medication usage is critical. Various methods have been attempted to increased HIV care compliance, and a method that has inspired many published studies is text message reminders. We conducted a meta-analysis of the literature from inception through May 2016 using the following databases: Pubmed, Embase, CINAHL, Web of Science, and Cochrane. Examples of terms used in the search included exploded versions of "HIV, "AIDS", "cell phone", "SMS", "text message", "reminder". After abstract and manuscript review, articles were discussed with co-author and included based on consensus. We excluded qualitative analyses, observational studies without an intervention, and studies without a control or pre-intervention group. We used random-effects models to calculate odds ratios (OR) and standardized mean differences (SMDs) for the text message intervention. Thirty-four unique studies were found and included in the meta-analysis. For the seven articles relating to non-attendance, text message reminders significantly reduced the rates of non-attendance (OR, 0.66; 95% CI, 0.48-0.92; P = .01; I2 = 52%). For the 20 articles on drug adherence, text message reminders significantly increased adherence (SMD, 0.87; 95% CI, 0.06-1.68; P = .04; I2 = 99%). For the 11 articles with physiologic measures (CD4 count or viral load), text message reminders led to significant improvement (SMD, 1.53; 95% CI, 0.52-2.55; P = .003; I2 = 99%). This meta-analysis reveals that text message reminders are a promising intervention that can be used to increase HIV care compliance when logistically feasible. Further study should focus on which populations benefit the most from this intervention, and successful implementers could create an established technological infrastructure for other clinics to adopt when seeking to boost compliance.
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Affiliation(s)
- Jonathan E Mayer
- a Department of Medicine , Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Paul Fontelo
- b National Library of Medicine , Lister Hill National Center for Biomedical Communications, National Institutes of Health , Bethesda , MD , USA
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Hancock NL, Stuart GS, Tang JH, Chibwesha CJ, Stringer JSA, Chi BH. Renewing focus on family planning service quality globally. Contracept Reprod Med 2016; 1:10. [PMID: 29201399 PMCID: PMC5693493 DOI: 10.1186/s40834-016-0021-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/25/2016] [Indexed: 11/10/2022] Open
Abstract
Reducing the global unmet need for contraception is currently a priority for many governments, multi-lateral initiatives, non-governmental organizations, and donors. Evidence strongly suggests that the provision of quality family planning services can increase uptake, prevalence, and continuation of contraception. While an accepted framework to define the components of family planning service quality exists, translating this framework into assessment tools that are accessible, easily utilized, and valid for service providers has remained a challenge. We propose new approaches to improve the standardization and accessibility of family planning service quality assessment tools to simplify family planning service quality evaluation. With easier approaches to program evaluation, quality improvements can be performed more swiftly to help increase uptake and continuation of contraception to improve the health of women and their families.
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Affiliation(s)
- Nancy L. Hancock
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Campus Box 7577, Chapel Hill, NC 27599-7577 USA
- Centre for Infectious Disease Research in Zambia, PO Box 34681, 5032 Great North Road, Lusaka, Zambia
| | - Gretchen S. Stuart
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Campus Box 7577, Chapel Hill, NC 27599-7577 USA
| | - Jennifer H. Tang
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Campus Box 7577, Chapel Hill, NC 27599-7577 USA
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Carla J. Chibwesha
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Campus Box 7577, Chapel Hill, NC 27599-7577 USA
| | - Jeffrey S. A. Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Campus Box 7577, Chapel Hill, NC 27599-7577 USA
| | - Benjamin H. Chi
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Campus Box 7577, Chapel Hill, NC 27599-7577 USA
- Centre for Infectious Disease Research in Zambia, PO Box 34681, 5032 Great North Road, Lusaka, Zambia
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Abstract
Approximately 50% of all pregnancies in women with epilepsy (WWE) occur unplanned. This is worrying, given the increased occurrence of obstetrical complications in WWE, including the risk of seizures and their possible consequences for both the mother and the unborn child. Hormonal contraception is usually regarded as highly effective, but it is subject to numerous bidirectional drug interactions with several antiepileptic drugs. These interactions may lead to loss of seizure control or contraceptive failure. Further concerns are loss of bone mineral density and increased seizure activity due to hormonal effects. Many physicians lack sufficient knowledge regarding these issues, and most WWE have never received adequate counseling. Moreover, several studies show that a large proportion of WWE do not take their medicines regularly. This article reviews all of these issues and offers practical recommendations for the management of contraception in WWE.
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Affiliation(s)
- Arne Reimers
- Department of Clinical Pharmacology, St Olavs University Hospital.,Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Villavicencio J, Allen RH. Unscheduled bleeding and contraceptive choice: increasing satisfaction and continuation rates. Open Access J Contracept 2016; 7:43-52. [PMID: 29386936 PMCID: PMC5683158 DOI: 10.2147/oajc.s85565] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Approximately half (51%) of the 6.6 million pregnancies in the US each year are unintended and half of those pregnancies (54%) occur among women not using contraception. Many women discontinue their contraceptives due to method dissatisfaction. Bothersome unscheduled bleeding is one of the main reasons cited by women for stopping a birth control method. Improving counseling and management of these side effects will aide in increasing satisfaction with contraceptive methods. The following review will discuss the bleeding profiles associated with the contraceptive options available in the US. A valuable resource from the Centers for Disease Control and Prevention, the US Selected Practice Recommendations for Contraceptive Use, will be introduced. Definitions of the types of unscheduled bleeding are included, as well as strategies for treatment for each contraceptive method. The evidence whether or not anticipatory counseling increases continuation rates will also be reviewed.
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Affiliation(s)
- Jennifer Villavicencio
- The Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rebecca H Allen
- The Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Lopez LM, Grey TW, Tolley EE, Chen M. Brief educational strategies for improving contraception use in young people. Cochrane Database Syst Rev 2016; 3:CD012025. [PMID: 27027480 PMCID: PMC7081122 DOI: 10.1002/14651858.cd012025.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Global high rates of unplanned pregnancy and abortion among young women demonstrate the need for increased access to modern contraceptive services. In sub-Saharan Africa, the birth rate for those aged 15 to 19 years is 121 per 1000. In the USA, 6% of teens aged 15 to 19 years became pregnant in 2010. Most pregnancies among young women to age 25 are unintended. OBJECTIVES The aim was to identify brief educational interventions for improving contraceptive use among young people that are feasible for implementing in a clinic or similar setting with limited resources. SEARCH METHODS To 7 March 2016, we searched for studies in CENTRAL, PubMed, POPLINE, Web of Science, ClinicalTrials.gov and ICTRP. SELECTION CRITERIA We considered randomized controlled trials (RCTs) that assigned individuals or clusters as well as non-randomized studies (NRS). We included young people to age 25.The intervention had to be sufficiently brief for a clinic, i.e. one to three sessions of 15 to 60 minutes plus potential follow-up. The strategy had to emphasize one or more effective methods of contraception. Primary outcomes were pregnancy and contraceptive use. DATA COLLECTION AND ANALYSIS We assessed titles and abstracts identified during the searches. One author extracted and entered the data into Review Manager; a second author verified accuracy. We examined studies for methodological quality.For dichotomous outcomes, we calculated the Mantel-Haenszel odds ratio (OR) with 95% confidence interval (CI). For continuous variables, we computed the mean difference (MD) with 95% CI. We used adjusted measures for cluster RCTs, typically ORs, that the investigators reported. For NRS, which need to control for confounding, we also used reported adjusted measures. We did not conduct meta-analysis due to varied interventions and outcome measures. MAIN RESULTS We found 11 studies, published from 1983 to 2015, that included a total of 8338 participants. Ten were from the USA and one was from China. We focused here on intervention effects for our primary outcomes. Five studies showed some effect on contraceptive use. Of three RCTs that examined innovative counseling, one showed an intervention effect. At one year, adolescents with developmental counseling were more likely to use contraception effectively than those with standard counseling (OR 48.38, 95% CI 5.96 to 392.63).Three studies used an audiovisual tool plus counseling; two reported some effect on contraceptive use. An NRS with young men, aged 15 to 18, examined a slide-tape presentation plus reproductive health consultation. At one year, the intervention group was more likely than the standard-care group to report using an effective contraceptive and having a partner who used oral contraceptives (OCs), both at last intercourse (reported adjusted OR 1.51 and 1.66, respectively). Another study utilized a computer program for contraceptive decision-making plus standard counseling for women to age 20. At one year, fewer women in the intervention group at one site had not used OCs compared with the counseling-only group (3.4% versus 8.8%; reported P = 0.05).Three RCTs provided phone follow-up after counseling, one of which showed an effect on contraceptive use among women age 16 to 24. Women who received counseling plus phone calls to encourage contraceptive use were more likely than the counseling-only group to report consistent OC use at three months (OR 1.41, 95% CI 1.06 to 1.87) and six months (OR 1.39, 95% CI 1.03 to 1.87). Also at three months, they were more likely to report condom use at last sex (OR 1.45, 95% CI 1.03 to 2.03).Two cluster randomized trials trained providers on contraceptive methods and counseling. One trial with an intervention effect tested comprehensive contraceptive services for women to age 25, postabortion. At six months, the comprehensive-service group was more likely than the standard-care group to use an effective contraceptive (reported adjusted OR 2.03, 95% CI 1.04 to 3.98) and to use condoms consistently and correctly (reported adjusted OR 5.68, 95% CI 3.39 to 9.53). AUTHORS' CONCLUSIONS Few studies tested brief strategies for young people. We noted heterogeneity across studies in participants' ages and life situations. Of five studies with some effect, one provided moderate-quality evidence; four were older studies with low-quality evidence. More intensive strategies could be more effective, but would also be challenging for many clinics to implement.
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Affiliation(s)
- Laureen M Lopez
- FHI 360Clinical and Epidemiological Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Thomas W Grey
- FHI 360Social and Behavioral Health Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Elizabeth E. Tolley
- FHI 360Social and Behavioral Health Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Mario Chen
- FHI 360Biostatistics359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
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Lopez LM, Grey TW, Tolley EE, Chen M. Brief educational strategies for improving contraception use in young people. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Smith C, Vannak U, Sokhey L, Ngo TD, Gold J, Free C. Mobile Technology for Improved Family Planning (MOTIF): the development of a mobile phone-based (mHealth) intervention to support post-abortion family planning (PAFP) in Cambodia. Reprod Health 2016; 13:1. [PMID: 26728505 PMCID: PMC4700587 DOI: 10.1186/s12978-015-0112-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 12/18/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The objective of this paper is to outline the formative research process used to develop the MOTIF mobile phone-based (mHealth) intervention to support post-abortion family planning in Cambodia. METHODS The formative research process involved literature reviews, interviews and focus group discussions with clients, and consultation with clinicians and organisations implementing mHealth activities in Cambodia. This process led to the development of a conceptual framework and the intervention. RESULTS Key findings from the formative research included identification of the main reasons for non-use of contraception and patterns of mobile phone use in Cambodia. We drew on components of existing interventions and behaviour change theory to develop a conceptual framework. A multi-faceted voice-based intervention was designed to address health concerns and other key determinants of contraception use. CONCLUSIONS Formative research was essential in order to develop an appropriate mHealth intervention to support post-abortion contraception in Cambodia. Each component of the formative research contributed to the final intervention design.
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Affiliation(s)
- Chris Smith
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1 7HT, UK.
| | - Uk Vannak
- Marie Stopes International, Phnom Penh, Cambodia
| | - Ly Sokhey
- Marie Stopes International, Phnom Penh, Cambodia
| | - Thoai D Ngo
- Research, Monitoring and Evaluation Team, Marie Stopes International, London, UK
| | | | - Caroline Free
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1 7HT, UK
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Sweeney LA, Molloy GJ, Byrne M, Murphy AW, Morgan K, Hughes CM, Ingham R. A Qualitative Study of Prescription Contraception Use: The Perspectives of Users, General Practitioners and Pharmacists. PLoS One 2015; 10:e0144074. [PMID: 26633191 PMCID: PMC4669182 DOI: 10.1371/journal.pone.0144074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 11/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The oral contraceptive pill (OCP) remains the most popular form of prescription contraception in many countries, despite adherence difficulties for many. Uptake of long acting reversible contraceptives (LARCs), which are less reliant on user adherence, remains low. The aim of this study was to explore the experiences of, and attitudes towards, prescription contraception amongst samples of contraception users, general practitioners (GPs) and pharmacists. METHODOLOGY AND FINDINGS We conducted a qualitative study using semi-structured interviews with 18 contraception users, 18 GPs and 9 pharmacists. The study took place in Galway, Republic of Ireland between June and September 2014. Thematic analysis was used to analyse the data. Overall, contraception users were more familiar with the OCP, and all the women interviewed began their prescription contraception journey using this method. All participants identified episodes of poor adherence throughout the reproductive life course. The identified barriers for use of LARCs were lack of information, misconceptions, lack of access and high cost. In contrast, GPs believed that adherence to the OCP was good and stated they were more likely to prescribe the OCP than other methods, as they were most familiar with this option. Barriers to prescribing LARCSs were time, cost to practice, training and deskilling. Pharmacists also believed that adherence to the OCP was generally good and that their role was limited to dispensing medication and providing information when asked. DISCUSSION AND CONCLUSION There are contrasting perspectives between contraception service providers and contraceptive users. Training for healthcare providers is required to support informed contraceptive choice and adherence. It is necessary to address the practice barriers of cost and lack of time, to promote better communication around adherence issues and prescription contraception options. There is a need for more easily-accessible public health information to promote awareness on all methods of prescription contraception.
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Affiliation(s)
- Leigh-Ann Sweeney
- School of Psychology, National University of Ireland, Galway, Republic of Ireland
- Whitaker Institute for Innovation and Societal Change, National University of Ireland, Galway, Republic of Ireland
| | - Gerard J. Molloy
- School of Psychology, National University of Ireland, Galway, Republic of Ireland
- Whitaker Institute for Innovation and Societal Change, National University of Ireland, Galway, Republic of Ireland
| | - Molly Byrne
- School of Psychology, National University of Ireland, Galway, Republic of Ireland
- Whitaker Institute for Innovation and Societal Change, National University of Ireland, Galway, Republic of Ireland
| | - Andrew W. Murphy
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Republic of Ireland
| | - Karen Morgan
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
- Perdana University Royal College of Surgeons in Ireland School of Medicine, Kuala Lumpur, Malaysia
| | - Carmel M. Hughes
- School of Pharmacy, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Roger Ingham
- Centre for Sexual Health Research, University of Southampton, Southampton, United Kingdom
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Leahy D, Treacy K, Molloy GJ. Conscientiousness and adherence to the oral contraceptive pill: A prospective study. Psychol Health 2015; 30:1346-60. [PMID: 26087993 DOI: 10.1080/08870446.2015.1062095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE We assess the association between conscientiousness and adherence to the oral contraceptive pill (OCP), and examine if such a relationship is independent of a measure of prospective memory and a range of social cognitive variables. METHOD Data were collected from 150 OCP users at baseline, and 99 provided follow-up data four weeks later. Conscientiousness, a range of social cognitive predictors and prospective memory were assessed at baseline. OCP adherence was measured at baseline, and again at Time 2. Data were analysed using correlation and multiple linear regression. RESULTS Higher conscientiousness was associated with higher overall OCP adherence in both cross-sectional (r = -0.28, p < 0.01) and prospective analysis (r = -0.34, p < 0.01). Conscientiousness predicted OCP adherence at Time 2, adjusting for OCP adherence at Time 1 (R(2) change = 0.02, p = 0.04). The association was reduced to non-significance when social cognitive predictors and prospective memory were included in the multivariable model. Prospective memory was an independent predictor of OCP adherence at Time 2. DISCUSSION This is the first study to identify an association between conscientiousness and OCP adherence. The association is not independent from social cognitive predictors and prospective memory. Facet-level analysis of conscientiousness and formal mediation analyses are recommended in future replications.
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Affiliation(s)
- D Leahy
- a School of Psychology , National University of Ireland , Galway , Ireland
| | - K Treacy
- a School of Psychology , National University of Ireland , Galway , Ireland
| | - G J Molloy
- a School of Psychology , National University of Ireland , Galway , Ireland
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Smith C, Gold J, Ngo TD, Sumpter C, Free C. Mobile phone-based interventions for improving contraception use. Cochrane Database Syst Rev 2015; 2015:CD011159. [PMID: 26115146 PMCID: PMC6485989 DOI: 10.1002/14651858.cd011159.pub2] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Contraception provides significant benefits for women's and children's health, yet an estimated 225 million women had an unmet need for modern contraceptive methods in 2014. Interventions delivered by mobile phone have been demonstrated to be effective in other health areas, but their effects on use of contraception have not been established. OBJECTIVES To assess the effects of mobile phone-based interventions for improving contraception use. SEARCH METHODS We searched for randomised controlled trials (RCTs) of client-provider interventions delivered by mobile phone to improve contraception use compared with standard care or another intervention. We searched the electronic databases Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Global Health, PsycINFO, POPLINE, Africa-Wide Information and Latin American Caribbean Health Sciences Literature (LILACS) from January 1993 to October 2014, as well as clinical trials registries, online mHealth resources and abstracts from key conferences. SELECTION CRITERIA Randomised controlled trials of mobile phone-based interventions to improve any form of contraception use amongst users or potential users of contraception. Outcome measures included uptake of contraception, measures of adherence, pregnancy and abortion. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts of studies retrieved using the search strategy and extracted data from the included studies. We calculated the Mantel-Haenszel risk ratio (RR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes, together with 95% confidence intervals (CIs). Differences in interventions and outcome measures did not permit us to undertake meta-analysis. MAIN RESULTS Five RCTs met our inclusion criteria. Three trials aimed to improve adherence to a specific method of contraception amongst existing or new contraception users by comparing automated text message interventions versus standard care. Two trials aimed to improve both uptake and adherence, not limited to one method, in both users and non-users of contraception. No trials were at low risk of bias in all areas assessed.One trial in the USA reported improved self reported oral contraceptive (OC) continuation at six months from an intervention comprising a range of uni-directional and interactive text messages (RR 1.19, 95% CI 1.05 to 1.35). One trial in Cambodia reported increased self reported use of effective contraception at four months post abortion from an intervention comprising automated interactive voice messages and phone counsellor support (RR 1.39, 95% CI 1.17 to 1.66).One feasibility trial in the USA reported a lower mean number of days between scheduled and completed attendance for the first but not subsequent Depo-Provera appointments using clinic records from an intervention comprising reminders and healthy self management text messages (mean difference (MD) -8.60 days, 95% CI -16.74 to -0.46). Simple text message OC reminders had no effect on missed pills as assessed by electronic medication monitoring in a small trial in the USA (MD 0.5 missed pills, 95% CI -1.08 to 2.08). No effect on self reported contraception use was noted amongst isotretinoin users from an intervention that provided health information via two uni-directional text messages and mail (RR 1.26, 95% CI 0.84 to 1.89). One trial assessed potential adverse effects of the intervention and reported no evidence of road traffic accidents or domestic abuse. AUTHORS' CONCLUSIONS Our review provides limited evidence that interventions delivered by mobile phone can improve contraception use. Whilst evidence suggests that a series of interactive voice messages and counsellor support can improve post-abortion contraception, and that a mixture of uni-directional and interactive daily educational text messages can improve OC adherence, the cost-effectiveness and long-term effects of these interventions remain unknown. Further high-quality trials are required to robustly establish the effects of interventions delivered by mobile phone to improve contraception use.
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Affiliation(s)
- Chris Smith
- London School of Hygiene & Tropical MedicineClinical Trials Unit, Department of Population HealthLondonUK
| | | | - Thoai D Ngo
- Innovations for Poverty ActionResearch and Knowledge Management Department101 Whitney AvenueNew Haven, ConnecticutCTUSA06510
| | - Colin Sumpter
- London School of Hygiene and Tropical MedicineLondonUK
| | - Caroline Free
- London School of Hygiene & Tropical MedicineClinical Trials Unit, Department of Population HealthLondonUK
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Abstract
This study aims to describe factors associated with the number of past abortions obtained by New York City (NYC) abortion patients in 2010. We calculated rates of first and repeat abortion by age, race/ethnicity, and neighborhood-level poverty and the mean number of self-reported past abortions by age, race/ethnicity, neighborhood-level poverty, number of living children, education, payment method, marital status, and nativity. We used negative binomial regression to predict number of past abortions by patient characteristics. Of the 76,614 abortions reported for NYC residents in 2010, 57% were repeat abortions. Repeat abortions comprised >50% of total abortions among the majority of sociodemographic groups we examined. Overall, mean number of past abortions was 1.3. Mean number of past abortions was higher for women aged 30-34 years (1.77), women with ≥5 children (2.50), and black non-Hispanic women (1.52). After multivariable regression, age, race/ethnicity, and number of children were the strongest predictors of number of past abortions. This analysis demonstrates that, although socioeconomic disparities exist, all abortion patients are at high risk for repeat unintended pregnancy and abortion.
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Affiliation(s)
- Amita Toprani
- Centers for Disease Control and Prevention Epidemic Intelligence Service, Atlanta, GA, USA,
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Abstract
Oral contraception (OC) remains a popular noninvasive, readily reversible approach for pregnancy prevention and, largely off label, for control of acne, hirsutism, dysmenorrhea, irregular menstruation, menorrhagia, and other menstrual-related symptoms. Many OC formulations exist, with generics offering lower cost and comparable efficacy. Certain medical conditions, including hypertension, migraine, breast cancer, and risk of venous thromboembolism (VTE), present contraindications. Blood pressure measurement is the only physical examination or testing needed before prescription. Although no OC is clearly superior to others, OCs containing the second-generation progestin levonorgestrel have been associated with lower VTE risk than those containing other progestins.
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Affiliation(s)
- Ginger Evans
- VA Puget Sound Health Care System, 1660 South Columbian Way, S-123-PCC, Seattle, WA 98108, USA.
| | - Eliza L Sutton
- Women's Health Care Center, University of Washington, 4245 Roosevelt Way Northeast, Box 354765, Seattle, WA 98105, USA
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