1
|
Jones HE, Manze M, Brakman A, Kwan A, Davies M, Romero D. Physician engagement in reproductive health advocacy: findings from a mixed methods evaluation of a leadership and advocacy program. BMC Med Educ 2024; 24:476. [PMID: 38689263 PMCID: PMC11061897 DOI: 10.1186/s12909-024-05410-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Medical curricula include advocacy competencies, but how much physicians engage in advocacy and what enables this engagement is not well characterized. The authors assessed facilitators and barriers to advocacy identified by physician alumni of a reproductive health advocacy training program. METHODS The authors present secondary results from a mixed methods program evaluation from 2018 to 2020, using alumni data from a cross-sectional survey (n = 231) and in-depth interviews (IDIs, n = 36). The survey measured engagement in policy, media, professional organization, and medical education advocacy and the value placed on the community fostered by the program (eight questions, Cronbach's alpha = 0.81). The authors estimated the association of community value score with advocacy engagement using multivariable Poisson regression to estimate prevalence ratios and analyzed IDI data inductively. RESULTS Over one third of alumni were highly engaged in legislative policy (n = 90, 39%), professional organizations (n = 98, 42%), or medical education (n = 89, 39%), with fewer highly active in media-based advocacy (n = 54, 23%) in the year prior to the survey. Survey and IDI data demonstrated that passion, sense of urgency, confidence in skills, and the program's emphasis on different forms of advocacy facilitated engagement in advocacy, while insufficient time, safety concerns, and sense of effort redundancies were barriers. The program community was also an important facilitator, especially for "out loud" efforts and for those working in environments perceived as hostile to abortion care (e.g., alumni in hostile environments with high community value scores were 1.8 times [95% CI 1.3, 2.6] as likely to report medium/high levels of media advocacy compared to those with low scores after adjusting for age, gender, and clinical specialty). CONCLUSION Physician advocacy training curricula should include both skills- and community-building and identify a full range of forms of advocacy. Community-building is especially important for physician advocacy for reproductive health services such as abortion care.
Collapse
Affiliation(s)
- Heidi E Jones
- City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), 55 W. 125th St #7th Floor, 10027, New York, NY, USA.
- City University of New York Institute of Implementation Science in Population Health (CUNY ISPH), New York, USA.
| | - Meredith Manze
- City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), 55 W. 125th St #7th Floor, 10027, New York, NY, USA
| | - Anita Brakman
- Physicians for Reproductive Health, Hartsdale, NY, USA
| | - Amy Kwan
- City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), 55 W. 125th St #7th Floor, 10027, New York, NY, USA
| | - MiQuel Davies
- Physicians for Reproductive Health, Hartsdale, NY, USA
| | - Diana Romero
- City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), 55 W. 125th St #7th Floor, 10027, New York, NY, USA
| |
Collapse
|
2
|
Barak O, Lovelace T, Piekos S, Chu T, Cao Z, Sadovsky E, Mouillet JF, Ouyang Y, Parks WT, Hood L, Price ND, Benos PV, Sadovsky Y. Integrated unbiased multiomics defines disease-independent placental clusters in common obstetrical syndromes. BMC Med 2023; 21:349. [PMID: 37679695 PMCID: PMC10485945 DOI: 10.1186/s12916-023-03054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Placental dysfunction, a root cause of common syndromes affecting human pregnancy, such as preeclampsia (PE), fetal growth restriction (FGR), and spontaneous preterm delivery (sPTD), remains poorly defined. These common, yet clinically disparate obstetrical syndromes share similar placental histopathologic patterns, while individuals within each syndrome present distinct molecular changes, challenging our understanding and hindering our ability to prevent and treat these syndromes. METHODS Using our extensive biobank, we identified women with severe PE (n = 75), FGR (n = 40), FGR with a hypertensive disorder (FGR + HDP; n = 33), sPTD (n = 72), and two uncomplicated control groups, term (n = 113), and preterm without PE, FGR, or sPTD (n = 16). We used placental biopsies for transcriptomics, proteomics, metabolomics data, and histological evaluation. After conventional pairwise comparison, we deployed an unbiased, AI-based similarity network fusion (SNF) to integrate the datatypes and identify omics-defined placental clusters. We used Bayesian model selection to compare the association between the histopathological features and disease conditions vs SNF clusters. RESULTS Pairwise, disease-based comparisons exhibited relatively few differences, likely reflecting the heterogeneity of the clinical syndromes. Therefore, we deployed the unbiased, omics-based SNF method. Our analysis resulted in four distinct clusters, which were mostly dominated by a specific syndrome. Notably, the cluster dominated by early-onset PE exhibited strong placental dysfunction patterns, with weaker injury patterns in the cluster dominated by sPTD. The SNF-defined clusters exhibited better correlation with the histopathology than the predefined disease groups. CONCLUSIONS Our results demonstrate that integrated omics-based SNF distinctively reclassifies placental dysfunction patterns underlying the common obstetrical syndromes, improves our understanding of the pathological processes, and could promote a search for more personalized interventions.
Collapse
Affiliation(s)
- Oren Barak
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - Tyler Lovelace
- Department of Computational and Systems Biology, University of Pittsburgh, 800 Murdoch Building, 3420 Forbes Avenue, Pittsburgh, PA, 15260, USA
- Joint CMU-Pitt PhD Program in Computational Biology, 800 Murdoch Building, 3420 Forbes Avenue, Pittsburgh, PA, 15260, USA
| | - Samantha Piekos
- Institute for Systems Biology, 401 Terri Avenue North, Seattle, WA, 98109, USA
| | - Tianjiao Chu
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - Zhishen Cao
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
| | - Elena Sadovsky
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
| | - Jean-Francois Mouillet
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - Yingshi Ouyang
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - W Tony Parks
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Simcoe Hall, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Leroy Hood
- Institute for Systems Biology, 401 Terri Avenue North, Seattle, WA, 98109, USA
| | - Nathan D Price
- Institute for Systems Biology, 401 Terri Avenue North, Seattle, WA, 98109, USA
- Thorne HealthTech, 152 West 57th Street, New York, NY, 10019, USA
| | - Panayiotis V Benos
- Department of Computational and Systems Biology, University of Pittsburgh, 800 Murdoch Building, 3420 Forbes Avenue, Pittsburgh, PA, 15260, USA
- Joint CMU-Pitt PhD Program in Computational Biology, 800 Murdoch Building, 3420 Forbes Avenue, Pittsburgh, PA, 15260, USA
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Yoel Sadovsky
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA.
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15213, USA.
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA, 15219, USA.
| |
Collapse
|
3
|
Manze M, Romero D, Kwan A, Ellsworth TR, Jones H. Physician perspectives of abortion advocacy: findings from a mixed-methods study. BMJ Sex Reprod Health 2023; 49:7-11. [PMID: 35396323 PMCID: PMC9872227 DOI: 10.1136/bmjsrh-2021-201394] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Our aim was to assess physicians' perspectives of what constitutes abortion advocacy and the skills needed to be effective in their efforts to safeguard legal abortion. METHODS Alumni from a physician training programme for sexual and reproductive health advocacy completed a cross-sectional survey including questions on perceived skills needed for effective advocacy. The research team conducted in-depth interviews (IDIs) with alumni, based on their level of engagement in advocacy. We present descriptive statistics for survey data and themes identified in the interview data using techniques informed by grounded theory. RESULTS Of the survey respondents (n=231), almost a third (28.6%; n=66) felt the most important media skill they learnt was the ability to stay on message. The most important policy skill was communicating effectively with policymakers (47.0%; n=108), followed by distilling evidence for policymakers and laypeople (13.0%; n=30). In the IDIs (n=36), participants reported activities such as media interviews as clear examples of advocacy, but also considered implementing institutional policies and abortion provision to be advocacy. They discussed how individual comfort and capacity for advocacy activities may change over time, given personal and professional considerations. Regardless of the type of activity, physicians valued strategic communication and relationship-building skills. CONCLUSIONS Based on our findings, training programmes that seek to mobilise physician advocates to advance sexual and reproductive health and rights should work with trainees to create a tailored advocacy plan that fits their personal and professional lives and goals. Regardless of the types of advocacy activities physicians focus on, strategic communication may be central in skills-based training.
Collapse
Affiliation(s)
- Meredith Manze
- Community Health and Social Sciences, CUNY School of Public Health, New York, New York, USA
| | - Diana Romero
- Community Health and Social Sciences, CUNY School of Public Health, New York, New York, USA
| | - Amy Kwan
- Community Health and Social Sciences, CUNY School of Public Health, New York, New York, USA
| | | | - Heidi Jones
- Department of Epidemiology and Biostatistics, CUNY School of Public Health, New York, New York, USA
| |
Collapse
|
4
|
Dobrowolska Zakaria JA, Bateman RJ, Lysakowska M, Khatri A, Jean-Gilles D, Kennedy ME, Vassar R. The metabolism of human soluble amyloid precursor protein isoforms is quantifiable by a stable isotope labeling-tandem mass spectrometry method. Sci Rep 2022; 12:14985. [PMID: 36056033 PMCID: PMC9440206 DOI: 10.1038/s41598-022-18869-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/22/2022] [Indexed: 11/19/2022] Open
Abstract
Evidence suggests that β-secretase (BACE1), which cleaves Amyloid Precursor Protein (APP) to form sAPPβ and amyloid-β, is elevated in Alzheimer's disease (AD) brains and biofluids and, thus, BACE1 is a therapeutic target for this devastating disease. The direct product of BACE1 cleavage of APP, sAPPβ, serves as a surrogate marker of BACE1 activity in the central nervous system. This biomarker could be utilized to better understand normal APP processing, aberrant processing in the disease setting, and modulations to processing during therapeutic intervention. In this paper, we present a method for measuring the metabolism of sAPPβ and another APP proteolytic product, sAPPα, in vivo in humans using stable isotope labeling kinetics, paired with immunoprecipitation and liquid chromatography/tandem mass spectrometry. The method presented herein is robust, reproducible, and precise, and allows for the study of these analytes by taking into account their full dynamic potential as opposed to the traditional methods of absolute concentration quantitation that only provide a static view of a dynamic system. A study of in vivo cerebrospinal fluid sAPPβ and sAPPα kinetics using these methods could reveal novel insights into pathophysiological mechanisms of AD, such as increased BACE1 processing of APP.
Collapse
Affiliation(s)
- Justyna A Dobrowolska Zakaria
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| | - Randall J Bateman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA
- SILQ Center, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Monika Lysakowska
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Ammaarah Khatri
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | | | - Matthew E Kennedy
- Deparment of Neuroscience, Merck & Co., Inc., Boston, MA, 02115, USA
| | - Robert Vassar
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| |
Collapse
|
5
|
Cohen SR, Baayd J, García G, Quade C, Gero A, Ekey M, Poggio C, Simmons R. Facility-based simulation as a programmatic tool for implementing a statewide contraceptive initiative. BMC Health Serv Res 2022; 22:965. [PMID: 35906656 PMCID: PMC9335456 DOI: 10.1186/s12913-022-08332-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessing implementation fidelity is highly recommended, but successful approaches can be challenging. Family Planning Elevated (FPE) is a statewide contraceptive initiative which partnered with 28 health clinics across Utah. To assess implementation fidelity, we developed in-situ high-fidelity simulation training to both determine clinic adherence to FPE and offer education to implementing teams. This study aimed to develop, pilot, and assess the use of simulation as a tool for measuring implementation fidelity. METHODS We developed two simulation scenarios to determine implementation fidelity: one scenario wherein a client is seeking a new method of contraception and another in which the same client has returned to discontinue the method. Both simulations contained multiple aspects of program implementation (e.g., determining program eligibility). We then offered simulations to all FPE partner organizations. To assess simulation training as a tool for determining implementation fidelity, we developed strategies aligned with each aspect of an adapted RE-AIM framework, including pre-post surveys, acceptability and self-efficacy testing, a checklist for programmatic adherence, field notes, action planning and analysis of monitoring data. RESULTS Fifteen clinical sites and 71 team members participated in the in-situ simulations. Assessment of the checklist showed that 90% of the clinics successfully demonstrated key program components, including person-centered counseling techniques such as sitting at the patient's level (95.8%); asking open-ended questions (100%); and explaining how to use the contraceptive method selected (91.7%). More than half of clinics fell short in programmatic areas including: confirmation that the FPE program covered same-day intrauterine device insertion (54.2%), and education on health risks associated with the selected contraceptive method (58.3%). After simulation, participants reported improved knowledge of how FPE works (p = < 0.001), increased ability to identify FPE-eligible clients (p = 0.02) and heightened self-efficacy in helping clients select a method (p = 0.03). Participants were satisfied with the simulations, with most (84.1%) reporting that the simulation exceeded their expectations. CONCLUSIONS Highly-realistic in-situ family planning simulations are acceptable to participants, positively change knowledge and clinical team confidence, and can identify systems gaps in clinical care and program implementation. Simulation offers a reciprocal way of monitoring implementation fidelity of a family planning access initiative. TRIAL REGISTRATION This project was determined to be exempt by the IRB of the University of Utah, the larger Family Planning Elevated program under which this pilot study was nested is registered at ClinicalTrials.gov Identifier: NCT03877757 .
Collapse
Affiliation(s)
- Susanna R Cohen
- LIFT Simulation Design Lab, Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
| | - Jami Baayd
- LIFT Simulation Design Lab, Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - Gabriela García
- LIFT Simulation Design Lab, Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - Caitlin Quade
- LIFT Simulation Design Lab, Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - Alexandra Gero
- LIFT Simulation Design Lab, Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - Madison Ekey
- LIFT Simulation Design Lab, Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - Catherine Poggio
- LIFT Simulation Design Lab, Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - Rebecca Simmons
- LIFT Simulation Design Lab, Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| |
Collapse
|
6
|
Cowan SK, Bruce TC, Perry BL, Ritz B, Perrett S, Anderson EM. Discordant benevolence: How and why people help others in the face of conflicting values. Sci Adv 2022; 8:eabj5851. [PMID: 35179964 PMCID: PMC8856616 DOI: 10.1126/sciadv.abj5851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
What happens when a request for help from friends or family members invokes conflicting values? In answering this question, we integrate and extend two literatures: support provision within social networks and moral decision-making. We examine the willingness of Americans who deem abortion immoral to help a close friend or family member seeking one. Using data from the General Social Survey and 74 in-depth interviews from the National Abortion Attitudes Study, we find that a substantial minority of Americans morally opposed to abortion would enact what we call discordant benevolence: providing help when doing so conflicts with personal values. People negotiate discordant benevolence by discriminating among types of help and by exercising commiseration, exemption, or discretion. This endeavor reveals both how personal values affect social support processes and how the nature of interaction shapes outcomes of moral decision-making.
Collapse
Affiliation(s)
- Sarah K. Cowan
- Department of Sociology, New York University, New York, NY, USA
| | - Tricia C. Bruce
- Center for the Study of Religion and Society, University of Notre Dame, Notre Dame, IN, USA
- Department of Sociology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Brea L. Perry
- Department of Sociology, Indiana University, Bloomington, IN, USA
| | - Bridget Ritz
- Center for the Study of Religion and Society, University of Notre Dame, Notre Dame, IN, USA
| | - Stuart Perrett
- Department of Sociology, New York University, New York, NY, USA
| | | |
Collapse
|
7
|
Abstract
Individual variation in morphology, physiology, and behavior has been a topic of great interest in the biological sciences. While scientists realize the importance of understanding diversity in individual phenotypes, historically the "minority" results (i.e., outlier observations or rare events) of any given experiment have been dismissed from further analysis. We need to reframe how we view "outliers" to improve our understanding of biology. These rare events are often treated as problematic or spurious, when they can be real rare events or individuals driving evolution in a population. It is our perspective that to understand what outliers can tell us in our data, we need to: (1) Change how we think about our data philosophically, (2) Fund novel collaborations using science "weavers" in our national funding agencies, and (3) Bridge long-term field and lab studies to reveal these outliers in action. By doing so, we will improve our understanding of variation and evolution. We propose that this shift in culture towards more integrative science will incorporate diverse teams, citizen scientists and local naturalists, and change how we teach future students.
Collapse
Affiliation(s)
- Chelsea N Cook
- Department of Biological Sciences, Marquette University, Milwaukee, WI 53233, USA
| | - Angela R Freeman
- Department of Psychology, Cornell University, Ithaca, NY 14853, USA
| | - James C Liao
- Department of Biology, Whitney Laboratory for Marine Bioscience, University of Florida, Gainesville, FL 32611, USA
| | - Lisa A Mangiamele
- Department of Biological Sciences, Smith College, Northampton, MA 01063, USA
| |
Collapse
|
8
|
Myers K, Sanders JN, Dalessandro C, Sexsmith CD, Geist C, Turok DK. The HER Salt Lake media campaign: comparing characteristics and outcomes of clients who make appointments online versus standard scheduling. BMC Womens Health 2021; 21:121. [PMID: 33757511 PMCID: PMC7986020 DOI: 10.1186/s12905-021-01256-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little research has examined how media outreach strategies affect the outcomes of contraceptive initiatives. Thus, this paper assesses the potential impact of an online media campaign introduced during the last six months of a contraceptive initiative study based in Salt Lake City, UT (USA). METHODS During the last six months of the HER Salt Lake Contraceptive Initiative (September 2016-March 2017), we introduced an online media campaign designed to connect potential clients to information about the initiative and a brief (9-item) appointment request form (via HERsaltlake.org). Using linked data from the online form and electronic medical records, we examine differences in demographics, appointment show rates, and contraceptive choices between "online requester" clients who made clinical appointments through the online form (n = 356) and "standard requester" clients who made appointments using standard scheduling (n = 3,051). We used summary statistics and multivariable regression to compare groups. RESULTS The campaign logged 1.7 million impressions and 15,765 clicks on advertisements leading to the campaign website (HERSaltLake.org). Compared to standard requesters, online requesters less frequently reported a past pregnancy and were more likely to be younger, white, and to enroll in the survey arm of the study. Relative to standard requesters and holding covariates constant, online requesters were more likely to select copper IUDs (RRR: 8.14), hormonal IUDs (RRR: 12.36), and implants (RRR: 10.75) over combined hormonal contraceptives (the contraceptive pill, patch, and ring). Uptake of the contraceptive injectable, condoms, and emergency contraception did not differ between groups. CONCLUSION Clients demonstrating engagement with the media campaign had different demographic characteristics and outcomes than those using standard scheduling to arrange care. Online media campaigns can be useful for connecting clients with advertised contraceptive methods and initiatives. However, depending on design strategy, the use of media campaigns might shift the demographics and characteristics of clients who participate in contraceptive initiatives. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT02734199, Registered 12 April 2016-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02734199 .
Collapse
Affiliation(s)
- Kyl Myers
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT, 84132, USA
| | - Jessica N Sanders
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT, 84132, USA
| | - Cristen Dalessandro
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT, 84132, USA.
| | - Corinne D Sexsmith
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT, 84132, USA
| | - Claudia Geist
- Department of Sociology and Division of Gender Studies, University of Utah, Salt Lake City, USA
| | - David K Turok
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, 2B200, Salt Lake City, UT, 84132, USA
| |
Collapse
|
9
|
Stillman M, Owolabi O, Fatusi AO, Akinyemi AI, Berry AL, Erinfolami TP, Olagunju OS, Väisänen H, Bankole A. Women's self-reported experiences using misoprostol obtained from drug sellers: a prospective cohort study in Lagos State, Nigeria. BMJ Open 2020; 10:e034670. [PMID: 32376752 PMCID: PMC7223139 DOI: 10.1136/bmjopen-2019-034670] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES This study aimed to assess the safety and effectiveness of self-managed misoprostol abortions obtained outside of the formal health system in Lagos State, Nigeria. DESIGN This was a prospective cohort study among women using misoprostol-containing medications purchased from drug sellers. Three telephone-administered surveys were conducted over 1 month. SETTING Data were collected in 2018 in six local government areas in Lagos State. PARTICIPANTS Drug sellers attempted to recruit all women who purchased misoprostol-containing medication. To remain in the study, participants had to be female and aged 18-49, and had to have purchased the medication for the purpose of abortion. Of 501 women initially recruited, 446 were eligible for the full study, and 394 completed all three surveys. PRIMARY AND SECONDARY OUTCOME MEASURES Using self-reported measures, we assessed the quality of information provided by drug sellers; the prevalence of potential complications; and the proportion with completed abortions. RESULTS Although drug sellers provided inadequate information about the pills, 94% of the sample reported a complete abortion without surgical intervention about 1 month after taking the medication. Assuming a conservative scenario where all individuals lost to follow-up had failed terminations, the completion rate dropped to 87%. While 86 women reported physical symptoms suggestive of complications, only six of them reported wanting or needing health facility care and four subsequently obtained care. CONCLUSIONS Drug sellers are an important source of medical abortion in this setting. Despite the limitations of self-report, many women appear to have effectively self-administered misoprostol. Additional research is needed to expand the evidence on the safety and effectiveness of self-use of misoprostol for abortion in restrictive settings, and to inform approaches that support the health and well-being of people who use this method of abortion.
Collapse
Affiliation(s)
- Melissa Stillman
- Department of Research, Guttmacher Institute, New York, New York, USA
| | - Onikepe Owolabi
- Department of Research, Guttmacher Institute, New York, New York, USA
| | - Adesegun O Fatusi
- Department of Research, Guttmacher Institute, New York, New York, USA
- Academy for Health Development (AHEAD), Ile-Ife, Nigeria
| | - Akanni I Akinyemi
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, United States
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Amanda L Berry
- Department of Research, Guttmacher Institute, New York, New York, USA
| | - Temitope P Erinfolami
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
- Centre for Research, Evaluation, Resources and Development (CRERD), Ile-Ife, Nigeria
| | - Olalekan S Olagunju
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
- Centre for Research, Evaluation, Resources and Development (CRERD), Ile-Ife, Nigeria
| | - Heini Väisänen
- Department of Social Statistics and Demography, University of Southampton, Southampton, Hampshire, UK
| | | |
Collapse
|
10
|
Abstract
BACKGROUND Professional guidelines indicate that pregnancy options counseling should be offered to pregnant women, in particular those experiencing an unintended pregnancy. However, research on whether pregnancy options counseling would benefit women as they enter prenatal care is limited. This study examines which women might benefit from options counseling during early prenatal care and whether women are interested in receiving counseling from their prenatal care provider. METHODS At four prenatal care facilities in Louisiana and Maryland, women entering prenatal care completed a self-administered survey and brief structured interview (N = 586). Data were analyzed through descriptive statistics, bivariate analyses, multivariate multinomial logistic regression, and coding of open-ended responses. RESULTS At entry into prenatal care, most women reported that they planned to continue their pregnancy and raise the child. A subset (3%) scored as having low certainty about their decision on the validated Decision Conflict Scale, indicating need for counseling. In addition, 9% of women stated that they would be interested in discussing their pregnancy options with their prenatal care provider. Regression analyses indicated some sociodemographic differences among women who are in need of or interested in options counseling. Notably, women who reported food insecurity in the prior year were found to be significantly more likely to be in need of options counseling (RRR = 3.20, p < 0.001) and interested in options counseling (RRR = 5.48, p < 0.001) than those who were food secure. Most women were open to discussing with their provider if their pregnancy was planned (88%) or if they had considered abortion (81%). More than 95% stated they would be honest with their provider if asked about these topics. CONCLUSIONS Most women are certain of their decision to continue their pregnancy at the initiation of prenatal care. However, there is a subset of women who, despite entering prenatal care, are uncertain of their decision and wish to discuss their options with their health care provider. Screening tools and/or probing questions are needed to support prenatal care providers in identifying these women and ensuring unbiased, non-directive counseling on all pregnancy options.
Collapse
Affiliation(s)
- Nancy F. Berglas
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612 USA
| | - Valerie Williams
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center New Orleans, 1542 Tulane Avenue, Box T5-2, New Orleans, LA 70112 USA
| | - Katrina Mark
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201 USA
| | - Sarah C. M. Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612 USA
| |
Collapse
|