Abstract
BackgroundThe Contraceptive CHOICE Project developed a patient-centered model for contraceptive provision including: (1) structured, evidence-based counseling; (2) staff and health care provider education; and (3) removal of barriers such as cost and multiple appointments to initiate contraception. In preparation for conducting a research study of the CHOICE model in three community health settings, we sought to identify potential barriers and facilitators to implementation.MethodsUsing a semi-structured interview guide guided by a framework of implementation research, we conducted 31 qualitative interviews with female patients, staff, and health care providers assessing attitudes, beliefs, and barriers to receiving contraception. We also asked about current contraceptive provision and explored organizational practices relevant to implementing the CHOICE model. We used a grounded theory approach to identify major themes.ResultsMany participants felt that current contraceptive provision could be improved by the CHOICE model. Potential facilitators included agreement about the necessity for improved contraceptive knowledge among patients and staff; importance of patient-centered contraceptive counseling; and benefits to same-day insertion of long-acting reversible contraception (LARC). Potential barriers included misconceptions about contraception held by staff and providers; resistance to new practices; costs associated with LARC; and scheduling challenges required for same-day insertion of LARC.ConclusionsIn addition to staff and provider training, implementing a patient-centered model of contraceptive provision needs to be supplemented by strategies to manage patient and system-level barriers. Community health center staff, providers, and patients support patient-centered contraceptive counseling to improve contraception provision if organizations can address these barriers.
Highlights
The Contraceptive CHOICE Project developed a patient-centered model for contraceptive provision including: (1) structured, evidence-based counseling; (2) staff and health care provider education; and (3) removal of barriers such as cost and multiple appointments to initiate contraception
Requirements for patients to return for a second visit for placement of an intrauterine device (IUD) or Politi et al Contraception and Reproductive Medicine (2016) 1:21 contraceptive implant can decrease the likelihood of initiation of these methods [9, 10]
Most Federally qualified health center (FQHC) staff and provider participants were over the age of 34 and held positions involving some degree of clinical interaction with patients
Summary
The Contraceptive CHOICE Project developed a patient-centered model for contraceptive provision including: (1) structured, evidence-based counseling; (2) staff and health care provider education; and (3) removal of barriers such as cost and multiple appointments to initiate contraception. Multiple barriers limit women’s access to and use of effective contraception. Out-of-pocket costs can limit women’s access to and appropriate use of many contraceptive methods [3, 4]; Patient out-of-pocket costs have only been partially addressed by the Affordable Care Act (ACA) due to challenges in implementation [5]. Clinician misconceptions may limit the use of highly effective methods such as intrauterine devices (IUDs) and implants among some women, especially among adolescents, nulliparous women, and women with a history of sexually transmitted infections [6,7,8]. Requirements for patients to return for a second visit for placement of an intrauterine device (IUD) or Politi et al Contraception and Reproductive Medicine (2016) 1:21 contraceptive implant can decrease the likelihood of initiation of these methods [9, 10]. Lack of post-visit contraceptive support further contributes to contraception non-adherence [11]
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