Reasons For Non-use Research Articles

Introducing the World Health Organization Labour Care Guide in Nigeria: Knowledge, Perceptions, and Impediments by Doctors and Nurses at 3-Tier Hospitals in Enugu, Nigeria

Abstract Context: It is speculated that obstetrics health workers in Nigeria may be lacking adequate knowledge of the Labour Care Guide (LCG) tool. Aim: To determine the awareness, level of knowledge, perceptions, and impediments toward use of the LCG tool for management of labor by doctors and nurses in Nigeria. Materials and Methods: This is a mixed-method study of 201 doctors and nurses at six selected health facilities in Enugu, Nigeria, over a 1-month period. For the quantitative component of the study, eligible and consenting participants were randomly selected and interviewed using a pretested questionnaire, while for the qualitative component, the six heads of labor ward nurses were purposively selected and in-depth interview conducted on the use, reasons for nonuse, and impediments to the use of LCG. Statistical Analysis: Statistical analysis was performed using IBM Statistical Package for Social Sciences for Windows, version 24.0 (Armonk, NY) for quantitative data. It was descriptive and inferential. The level of significance was set at P < 0.05. For qualitative data, thematic analysis was done. Result: A total of 168 (83.6%) were aware of LCG; 60 (35.7%) had poor knowledge (mean score: 20.1 ± 7.5), and 89 (53.0%) had negative perception (mean score: 0.11 ± 0.11). Impediments to LCG use included being time-consuming, insufficient manpower, insufficient knowledge, and lack of training. Negative perception was associated with poor knowledge of LCG (P < 0.001, AOR =60.9, CI =13.9-267.1). Conclusion: One in three obstetric care workers has poor knowledge of LCG in labor care. We recommend creating training opportunities for them at all levels of healthcare on the use of LCG.

Contraceptive Behavior in Appalachia: Exploring Use, Nonuse, and Contraceptive Attitudes.

Very little is known about contraceptive behavior in Appalachia, a large geographic region in the eastern United States where even basic prevalence estimates of contraceptive use/nonuse are lacking. This study characterizes contraceptive behavior among Appalachians, including contraceptive use, reasons for use, and methods used; contraceptive nonuse and reasons for nonuse; and attitudes about contraception, including acceptability. This is a secondary analysis of a subsample of survey data collected on sexual and reproductive health attitudes, behaviors, and needs among reproductive-age women (18-49 years) living in the Appalachian region (n = 332). Results identify rates of contraceptive use (66.6%) and nonuse (33.1%) among Appalachian residents. Methods used most frequently included those that did not require prescription (i.e., external condoms and natural family planning methods) though many reported the use of intrauterine devices (IUDs). Among nonusers, fear of side effects from contraception and ambivalence towards pregnancy were most commonly selected as the most important reason for not using contraception. Contraception was considered acceptable by this sample overall, and these acceptability attitudes were significantly associated with contraceptive behavior.

Out-of-pocket costs and affordability of upper limb prostheses.

Given the funding policies in the Department of Veterans Affairs, the affordability of prostheses may be less of a concern among Veterans as compared to civilians. Compare rates of out-of-pocket prosthesis-related payments for Veterans and non-Veterans with upper limb amputation (ULA), develop and validate a measure of prosthesis affordability, and evaluate the impact of affordability on prosthesis nonuse. Telephone survey of 727 persons with ULA; 76% Veterans and 24% non-Veterans. Odds of paying out-of-pocket costs for Veterans compared with non-Veterans were computed using logistic regression. Cognitive and pilot testing resulted in a new scale, evaluated using confirmatory factor and Rasch analysis. Proportions of respondents who cited affordability as a reason for never using or abandoning a prosthesis were calculated. Twenty percent of those who ever used a prosthesis paid out-of-pocket costs. Veterans had 0.20 odds (95% confidence interval, 0.14-0.30) of paying out-of-pocket costs compared with non-Veterans. Confirmatory factor analysis supported unidimensionality of the 4-item Prosthesis Affordability scale. Rasch person reliability was 0.78. Cronbach alpha was 0.87. Overall, 14% of prosthesis never-users said affordability was a reason for nonuse; 9.6% and 16.5% of former prosthesis users said affordability of repairs or replacement, respectively, was a reason for abandonment. Out-of-pocket prosthesis costs were paid by 20% of those sample, with Veterans less likely to incur costs. The Prosthesis Affordability scale developed in this study was reliable and valid for persons with ULA. Prosthesis affordability was a common reason for never using or abandoning prostheses.

Determinants of Hormone Replacement Therapy Knowledge and Current Hormone Replacement Therapy Use.

Background: The use of hormone replacement therapy (HRT) to treat menopausal symptoms has declined since the early 2000s, and little is known about the contemporary determinants of use in the United States. We aim to understand women's knowledge of HRT as a treatment of menopausal symptoms and to assess the factors associated with HRT use. Materials and Methods: Weighted multivariate logistic regression models evaluated the correlates of high HRT knowledge and current HRT use among a sample of 2,548 women aged ≥45 years who participated in an online survey between August 2019 and May 2020. Results: In total, 82% of the women surveyed reported experiencing one or more menopausal symptoms, yet only 10.5% reported using HRT. Only 33% reported high HRT knowledge. The odds of reporting high HRT knowledge increased with increasing age. Racial, ethnic minority women were less likely to report high HRT knowledge (adjusted odds ratio [AOR] = 0.69; 95% confidence interval [CI] = 0.5-0.9). Hispanic and non-Hispanic women of other racial and ethnic groups were less likely to use HRT compared with non-Hispanic White women (AOR = 0.3; 95% CI = 0.1-0.6) (AOR = 0.4; CI = 0.2-0.9), respectively. Women experiencing irregular periods were less likely to report current HRT use (AOR = 0.1, 95% CI = 0.4-0.7). Compared with past users, never users appeared to be more risk averse, and reported concern over HRT risks and side effects as reasons for nonuse. Conclusions: Many factors impact women's perceived HRT knowledge level and to a lesser extent HRT use. Future research should better define the most important factors influencing decisions to use HRT for symptom relief.

On Networking the Writing Center: Social Media Usage and Non-Usage

This article presents findings from an IRB-approved study about writing center social media use and nonuse using survey data keyed to five factors: reasons for nonuse; purposes for use; platforms used; approaches to use that consider platforms and target audiences; and recommendations to other writing centers to use or not use social media. While the 91 writing centers not using social media commonly cited a lack of time, lack of staff, and lack of experience as reasons, the majority of writing centers in this study maintained a social media presence. These 153 writing centers tended to use multiple platforms, commonly to promote the center and reach other writing centers, and often perceived students and faculty as their target audiences. A majority of the 244 respondents recommend social media use to other writing centers regardless of their own center’s usage or non-usage. The study not only aimed to provide more and more in-depth data about writing center social media use and nonuse; it also considered conversations about writing center purpose as presented to a diverse audience that included administrators outside of writing centers and underscores the potential for writing centers to produce multimodal writing on such platforms.

Disparities in patient portal access by US adults before and during the COVID-19 pandemic.

Online patient portals become important during disruptions to in-person health care, like when cases of coronavirus disease 2019 (COVID-19) and other respiratory viruses rise, yet underlying structural inequalities associated with race, socio-economic status, and other socio-demographic characteristics may affect their use. We analyzed a population-based survey to identify disparities within the United States in access to online portals during the early period of COVID-19 in 2020. The National Cancer Institute fielded the 2020 Health and Information National Trends Survey from February to June 2020. We conducted multivariable analysis to identify socio-demographic characteristics of US patients who were offered and accessed online portals, and reasons for nonuse. Less than half of insured adult patients reported accessing an online portal in the prior 12 months, and this was less common among patients who are male, are Hispanic, have less than a college degree, have Medicaid insurance, have no regular provider, or have no internet. Reasons for nonuse include: wanting to speak directly to a provider, not having an online record, concerns about privacy, and discomfort with technology. Despite the rapid expansion of digital health technologies due to COVID-19, we found persistent socio-demographic disparities in access to patient portals. Ensuring that digital health tools are secure, private, and trustworthy would address some patient concerns that are barriers to portal access. Expanding the use of online portals requires explicitly addressing fundamental inequities to prevent exacerbating existing disparities, particularly during surges in cases of COVID-19 and other respiratory viruses that tax health care resources.

Using deep learning-based natural language processing to identify reasons for statin nonuse in patients with atherosclerotic cardiovascular disease

BackgroundStatins conclusively decrease mortality in atherosclerotic cardiovascular disease (ASCVD), the leading cause of death worldwide, and are strongly recommended by guidelines. However, real-world statin utilization and persistence are low, resulting in excess mortality. Identifying reasons for statin nonuse at scale across health systems is crucial to developing targeted interventions to improve statin use.MethodsWe developed and validated deep learning-based natural language processing (NLP) approaches (Clinical Bidirectional Encoder Representations from Transformers [BERT]) to classify statin nonuse and reasons for statin nonuse using unstructured electronic health records (EHRs) from a diverse healthcare system.ResultsWe present data from a cohort of 56,530 ASCVD patients, among whom 21,508 (38%) lack guideline-directed statin prescriptions and statins listed as allergies in structured EHR portions. Of these 21,508 patients without prescriptions, only 3,929 (18%) have any discussion of statin use or nonuse in EHR documentation. The NLP classifiers identify statin nonuse with an area under the curve (AUC) of 0.94 (95% CI 0.93–0.96) and reasons for nonuse with a weighted-average AUC of 0.88 (95% CI 0.86–0.91) when evaluated against manual expert chart review in a held-out test set. Clinical BERT identifies key patient-level reasons (side-effects, patient preference) and clinician-level reasons (guideline-discordant practices) for statin nonuse, including differences by type of ASCVD and patient race/ethnicity.ConclusionsOur deep learning NLP classifiers can identify crucial gaps in statin nonuse and reasons for nonuse in high-risk populations to support education, clinical decision support, and potential pathways for health systems to address ASCVD treatment gaps.

Dismantling Barriers and Transforming the Future of Pre-Exposure Prophylaxis Uptake in Young Black and Latinx Sexual Minority Men and Transgender Women.

Pre-exposure prophylaxis (PrEP) has the potential to transform HIV in young Black and Latinx sexual minority men (SMM) and transgender women (TW). Addressing low PrEP uptake in this population depends on the better understanding of barriers to PrEP use. This article uses an ecological framework to explore barriers to daily oral PrEP in a sample of young Black and Latinx SMM and TW in three geographically prioritized cities in the United States. In-depth interviews were completed with 33 young Black and Latinx SMM and TW (22 at risk for and 11 recently diagnosed with HIV), aged 17-24, participating in a randomized trial aimed at increasing PrEP and antiretroviral therapy (ART) uptake and adherence. Interviews were recorded and transcribed, and then analyzed using inductive and deductive coding. Coded transcripts were organized into individual, interpersonal, community, and structural categories, by PrEP use and HIV status. Among participants, nine reported having been prescribed PrEP, with five actively or recently taking PrEP, whereas only one participant diagnosed with HIV had been prescribed PrEP. Major themes related to barriers emerged across the individual, family, community, and structural level. Limited barriers related to partners, instead partners with HIV encouraged PrEP use. Participants commonly reported low perceived HIV risk, fear of disclosure, barriers relating to insurance/cost, and medication use as reasons for nonuse of PrEP. For youth to remain on a healthy life course, HIV preventative measures will need to be adopted early in adolescence for those at risk of HIV acquisition. Interventions need to simultaneously address multilevel barriers that contribute to nonuse in adolescents. Clinical trials registry site and number: ClinicalTrials.gov Identifier: NCT03194477.

Reasons for Nonuse, Discontinuation of Use, and Acceptance of Additional Functionalities of a COVID-19 Contact Tracing App: Cross-sectional Survey Study.

BackgroundIn several countries, contact tracing apps (CTAs) have been introduced to warn users if they have had high-risk contacts that could expose them to SARS-CoV-2 and could, therefore, develop COVID-19 or further transmit the virus. For CTAs to be effective, a sufficient critical mass of users is needed. Until now, adoption of these apps in several countries has been limited, resulting in questions on which factors prevent app uptake or stimulate discontinuation of app use.ObjectiveThe aim of this study was to investigate individuals’ reasons for not using, or stopping use of, a CTA, in particular, the Coronalert app. Users’ and nonusers’ attitudes toward the app’s potential impact was assessed in Belgium. To further stimulate interest and potential use of a CTA, the study also investigated the population’s interest in new functionalities.MethodsAn online survey was administered in Belgium to a sample of 1850 respondents aged 18 to 64 years. Data were collected between October 30 and November 2, 2020. Sociodemographic differences were assessed between users and nonusers. We analyzed both groups’ attitudes toward the potential impact of CTAs and their acceptance of new app functionalities.ResultsOur data showed that 64.9% (1201/1850) of our respondents were nonusers of the CTA under study; this included individuals who did not install the app, those who downloaded but did not activate the app, and those who uninstalled the app. While we did not find any sociodemographic differences between users and nonusers, attitudes toward the app and its functionalities seemed to differ. The main reasons for not downloading and using the app were a perceived lack of advantages (308/991, 31.1%), worries about privacy (290/991, 29.3%), and, to a lesser extent, not having a smartphone (183/991, 18.5%). Users of the CTA agreed more with the potential of such apps to mitigate the consequences of the pandemic. Overall, nonusers found the possibility of extending the CTA with future functionalities to be less acceptable than users. However, among users, acceptability also tended to differ. Among users, functionalities relating to access and control, such as digital certificates or “green cards” for events, were less accepted (358/649, 55.2%) than functionalities focusing on informing citizens about the spread of the virus (453/649, 69.8%) or making an appointment to get tested (525/649, 80.9%).ConclusionsOur results show that app users were more convinced of the CTA’s utility and more inclined to accept new app features than nonusers. Moreover, nonusers had more CTA-related privacy concerns. Therefore, to further stimulate app adoption and use, its potential advantages and privacy-preserving mechanisms need to be stressed. Building further knowledge on the forms of resistance among nonusers is important for responding to these barriers through the app’s further development and communication campaigns.

A Mobile App to Enhance Behavioral Activation Treatment for Substance Use Disorder: App Design, Use, and Integration Into Treatment in the Context of a Randomized Controlled Trial.

BackgroundGroup-based formats typically used in low-resource substance use disorder (SUD) treatment settings result in little individual attention to help reinforce and guide skill use, which may contribute to poor posttreatment outcomes. Smartphone apps offer a convenient, user-friendly, and cost-effective tool that can extend the reach of effective SUD treatments. A smartphone app was developed and integrated into a group-based, brief behavioral activation (BA) treatment for SUD to increase engagement in treatment skills outside clinician-administered sessions.ObjectiveThis study aims to describe the features of the app and its use and integration into treatment, report the participants’ self-reported feasibility and acceptability of the app, and discuss challenges and provide recommendations for future smartphone app integration into behavioral treatments for SUD.MethodsA total of 56 individuals recruited from intensive outpatient SUD treatment received a smartphone-enhanced BA treatment, the Life Enhancement Treatment for Substance Use. Self-reported weekly app use and reasons for nonuse were assessed at posttreatment and at 1- and 3-month follow-ups. In addition, 2-tailed t tests and chi-square tests compared the self-reported use of each app component and overall app use over time.ResultsParticipant feedback suggested that the integration of the smartphone app into the Life Enhancement Treatment for Substance Use was feasible and well accepted, and participants found the app useful for planning value-based activities outside of sessions. Self-reported app engagement decreased over the follow-up period: 72% (39/54) of participants reported using the app at posttreatment, decreasing to 69% (37/54) at the 1-month follow-up and 37% (20/54) at the 3-month follow-up. Participants reported forgetting to use the app as a primary reason for nonuse.ConclusionsThis study provides support for the feasibility and acceptability of smartphone-enhanced BA treatment, offering promise for future research testing the integration of technology into SUD treatment. Design decisions may help streamline smartphone integration into treatment, for example, allowing participants to download the treatment app on their own phones or use a low-cost study smartphone (or offering both options). Long-term app engagement may be increased via built-in reminders, alerts, and in-app messages.Trial RegistrationClinicalTrials.gov NCT02707887; https://clinicaltrials.gov/ct2/show/study/NCT02707887

Forgoing plans for alcohol and cannabis use in daily life: Examining reasons for nonuse when use was planned in a predominantly white college student sample.

The reasons for college students to abstain from alcohol and cannabis use on a given day can inform efforts to prevent or intervene in those behaviors. Research on reasons for alcohol nonuse remains in its nascent stages and no study to date has examined reasons for cannabis nonuse on a given day. Here we examine reasons for nonuse among college students after they planned to use alcohol and/or cannabis. College students (N=341; Mage =19.79; 53% women; 74% White) from 3 universities completed 54days of data collection across which approximately 50% were nonuse days. Each morning, participants indicated whether they planned to use that day; nonuse reasons were assessed the next morning, if applicable. Generalized linear mixed-effects models were used to disentangle within- and between-person effects. On a given nonuse day (at the within-person level), "work" and "school" were reasons associated with having no plan to use alcohol and "to feel in control" was linked to having no plan to use cannabis. "Did not want to get high" was related to forgoing plans (did not use when originally planned) for alcohol use at the within-person level. At the between-person level, "no desire" was associated with no plans for alcohol or cannabis use and "did not want to get high" was related to no plans for cannabis use. "School" and "could not get" were related to forgoing plans for alcohol and cannabis use, respectively, at the between-person level. An examination of earlier intentions for alcohol and/or cannabis use on nonuse days yielded novel findings on the intention-behavior gap. Reasons for nonuse can inform intervention and prevention strategies (e.g., those involving social norms or just-in-time adaptive efforts) for alcohol and cannabis use on college campuses.

Telehealth was beneficial during COVID-19 for older Americans: A qualitative study with physicians.

BackgroundIndividuals aged 65 and older face unique barriers to adoption of telehealth, and the coronavirus disease 2019 pandemic has provided a “natural experiment” in how to meet the health needs of older patients remotely. Physician perspectives on practical considerations surrounding telehealth adoption, motivations of use, and reasons for nonuse are necessary to inform the future of healthcare delivery. The objective is to understand the experiences of physicians using telemedicine for older patients.MethodsFrom September to November 2020, we conducted 30‐min semi‐structured interviews using purposeful sampling to identify and enroll participants from diverse settings. We included 48 U.S.‐based physicians (geriatrician, n = 18, primary care, n = 15, emergency, n = 15) from all geographic regions, rural–urban and academic/community settings. Audio‐recorded interviews were professionally transcribed and analyzed using framework analysis. Major themes and subthemes were identified.ResultsParticipants had a median (interquartile range) age of 37.5 (34–44.5), 27 (56%) were women. Five major themes emerged: (1) telehealth uptake was rapid and iterative, (2) telehealth improved the safety of medical care, (3) use cases were specialty‐specific (for geriatricians and primary care physicians telehealth substituted for in‐person visits; for emergency physicians it primarily supplemented in‐person visits), (4) physicians altered clinical care to overcome older patient barriers to telehealth use, and (5) telehealth use among physicians declined in mid‐April 2020, due primarily to patient needs and administrator preferences, not physician factors.ConclusionIn this qualitative analysis, physicians reported a rapid, iterative uptake of telehealth and attenuation of use as coronavirus disease 2019 prevalence declined. Physician experiences during the pandemic can inform interventions and policies to help buoy telehealth for ongoing healthcare delivery and ensure its accessibility for older Americans.

Sociodemographic Characteristics of HIV Pre-Exposure Prophylaxis Use and Reasons for Nonuse Among Gay, Bisexual, and Other Men Who Have Sex with Men from Three US Cities.

HIV pre-exposure prophylaxis (PrEP) is a preventive medication that could reduce new infections among men who have sex with men (MSM). There are limited data on differing reasons for PrEP nonuse by condomless anal sex (CAS). We examined demographic and behavioral variables associated with PrEP use and reasons for PrEP nonuse by CAS. Data are from the M-cubed Study, collected in a 2018 baseline assessment of MSM (n = 798) in Atlanta, Detroit, and New York City. Participants reported current PrEP use (31%), previous use (8%), and never use (61%). MSM reporting CAS [adjusted odds ratio (aOR) = 2.60, confidence interval (95% CI) = 1.73-3.91], age 18-29 (aOR = 2.11, 95% CI = 1.26-3.52), 30-39 (aOR = 2.12, 95% CI = 1.25-3.59), with a college degree (aOR = 1.96, 95% CI = 1.20-3.21), or postgraduate education (aOR = 2.58, 95% CI = 1.51-4.40) had greater odds of current (vs. never) use; uninsured (aOR = 0.30, 95% CI = 0.16-0.57) men had lower odds of current (vs. never) use. For never use, more MSM who reported CAS (vs. did not) endorsed the following reasons (p's < 0.05): Insurance wouldn't cover PrEP (20% vs. 12%), Didn't know where to get it (33% vs. 24%) and fewer reported Didn't need PrEP (23% vs. 39%) and Started a committed relationship (7% vs. 25%). For discontinuation, more MSM who reported CAS (vs. did not) endorsed Worry about the safety of PrEP (19% vs. 3%). Efforts are needed to enhance PrEP as an option among older, less educated, and uninsured MSM. These findings may inform how providers can facilitate PrEP use by messaging on access and safety for MSM who reported CAS.

A study of knowledge and practice of contraception in a rural area of Bareilly, Uttar Pradesh

Background: It is very critical to understand that awareness of family planning and proper utilization of contraceptives is an important indicator for reducing maternal and neonatal mortality and morbidity. It also plays an important role in promoting reproductive health of the women in an underdeveloped country. Objective was to assess knowledge and practice of modern contraception in rural area.Methods: A community based cross sectional study. A cross-sectional descriptive study was carried out in the in a rural area of Bareilly, Uttar Pradesh. 458 randomly selected eligible couples were included in the study. A pre-structured questionnaire was used to collect information about family planning methods knowledge, source of knowledge and current practices and reasons of nonuse. The appropriate statistical analysis was done to present the results.Results: 48.03% eligible couples had adopted one or the other current modern contraceptive measure. Female sterilization was the most common method used.Conclusions: Overall usage of postpartum contraception was low need to focus at every step to contact with health facility or health workers.

Use of nonpreferred contraceptive methods among women in Ohio

ObjectivesWe describe the prevalence and correlates of nonuse of preferred contraceptive method among women 18-44 years of age in Ohio using contraception. Study DesignThe population-representative Ohio Survey of Women had 2529 participants in 2018–2019, with a response rate of 33.5%. We examined prevalence of preferred method nonuse, reasons for nonuse, and satisfaction with current method among current contraception users (n = 1390). We evaluated associations between demographic and healthcare factors and preferred method nonuse. ResultsAbout 25% of women reported not using their preferred contraceptive method. The most common barrier to obtaining preferred method was affordability (13%). Those not using their preferred method identified long-acting methods (49%), oral contraception (33%), or condoms (21%) as their preferred methods. The proportion using their preferred method was highest among intrauterine device (IUD) users (86%) and lowest among emergency contraception users (64%). About 16% of women using permanent contraception reported it was not their preferred method. Having the lowest socioeconomic status (versus highest) (prevalence ratio [PR]: 1.47, 95% CI: 1.11–1.96), Hispanic ethnicity (versus non-Hispanic white) (PR: 1.83, 95% CI: 1.15–2.90), reporting poor provider satisfaction related to contraceptive care (PR: 2.33, 95% CI: 1.02–5.29), and not having a yearly women's checkup (PR: 1.31, 95% CI: 1.01–1.68) were significantly associated with nonuse of preferred method. Compared to preferred-method nonusers, higher proportions of preferred-method users reported consistent contraceptive use (89% vs. 73%, p < 0.001) and intent to continue use (79% vs. 58%, p < 0.001). ConclusionsAffordability and poor provider satisfaction related to contraceptive care were associated with nonuse of preferred contraceptive method. Those using their preferred method reported more consistent use. ImplicationsCost is an important barrier for women in obtaining their preferred contraceptive methods. Low quality birth control care may also be a barrier to preferred-method use. Removal of cost barriers and improvement in contraceptive counseling strategies may increase access to preferred contraceptive methods.

Contraceptive awareness, and practices among rural women in Lucknow

Objective: This cross sectional observational study was done to asses awareness regarding family planning methods and the practice of contraceptives among rural women in Lucknow. Materials and Methods: Five hundred women between the ages of 15-45 years, living with their husbands and coming from rural area, attending gynecology OPD of integral institute of medical sciences and research, Dasauli, Lucknow were included in this study. Women who were pregnant, had a child younger than 2 years, or had any medical disorder were excluded. Their knowledge, source of knowledge and practice of contraceptives were evaluated with the help of a predesigned questionnaire. The other variables used were the age of women, parity, religion and educational status. Results were expressed as percentages. Results: Out of 500 interviewed majority of women (49.2%) were between 22-25 years of age. 61% were illiterate belonging to low socioeconomic status, 63.3% belonged to Hindu religion. In the present study, it was observed that, 94.4% had some knowledge about family planning methods, and almost all (94.4%) of them were aware about Cu T and oral pills. The media and social circle were provided information of contraceptives in 46.6% women. Regarding the usage of contraceptive methods, 41.2% of the respondents were using some sort of contraception. Barrier method (condoms) was in practice by 26.8%, pills in 5.6%. Cu T users were 3.2% and 1.2% were using DMPA for contraception. 4.4% of women had already undergone tubal ligation. It was noted that awareness about pills and Copper was good, but their practices were very low. There were multiple reasons for non use like fear of side effects, no support from the husbands, low fertility, inhibition to ask about the contraceptives. Conclusion: There is need for strong motivation of couples through media and health personnel to achieve effective use of contraceptives, specially for Cu T and oral pills. Keywords: Contraception, Awareness, Prac

Prevalence and Characteristics of Telehealth Utilization in the United States

Telehealth services, which allow patients to communicate with a remotely located clinician, are increasingly available; however, prevalence of telehealth use, including videoconferencing visits, remains unclear. To measure the use of and willingness to use telehealth modalities across the US population. This survey study, conducted between February 2019 and April 2019, asked participants about their use of different telehealth modalities, reasons for not using videoconferencing visits, and willingness to use videoconferencing visits. Questions were continuously posed to panel members and closed after 2555 responses were obtained, at which point 3932 panel members had been invited, for a 65.0% response rate. Demographic characteristics (ie, age, sex, race, rural/urban residency, education level, and income). Self-reported use of specific telehealth modalities, reasons for nonuse, and willingness to use videoconferencing in the future. A total of 2555 individuals completed the survey with a mean (SD) age of 57.2 (14.2) years; 1453 respondents (weighted percentage, 51.9%) were women, and 2043 (weighted percentage, 73.4%) were White individuals. Overall, 1343 respondents (weighted percentage, 50.8%) reported use of a nontelephone telehealth modality, ranging from 873 respondents (weighted percentage, 31.9%) for patient portals and 89 respondents (weighted percentage, 4.2%) for videoconferencing visits. Although 1309 respondents (weighted percentage, 49.2%) overall answered that they were willing or very willing to use videoconferencing visits, respondents who were Black individuals (OR, 0.58; 95% CI, 0.38-0.91), aged older than 65 years (OR, 0.51; 95% CI, 0.40-0.66), or had less education (high school or less vs advanced degrees: OR, 0.37; 95% CI, 0.25-0.56) were less likely to express willingness. Despite the focused policy attention on videoconferencing visits, the results of this survey study suggest that other forms of telehealth were more dominant prior to 2020. Targeted efforts may be necessary for videoconferencing visits to reach patient groups who are older or have less education, and payer policies supporting other forms of telemedicine may be appropriate to enhance access.

Is Patient Navigation Used by People with HIV Who Need It? An Assessment from the Medical Monitoring Project, 2015 - 2017.

We (1) estimated the prevalence of not getting patient navigation despite feeling a need for the service (unmet subjective need) or despite having unsuppressed viral load (unmet objective need) among people with HIV (PWH), (2) determined reasons why PWH did not use the service, and (3) determined factors associated with unmet need for patient navigation. We used combined data from the 2015 to 2017 cycles of the Medical Monitoring Project, an HIV surveillance system designed to produce nationally representative estimates of the characteristics of adults with diagnosed HIV infection in the United States. Six percent reported unmet subjective need and 28% had unmet objective need for patient navigation. When needs were combined, more than a third had unmet need for the service. Among PWH with unmet subjective need for patient navigation, 77% reported lack of knowledge about patient navigation as a reason for nonuse. Younger age, female gender, racial/ethnic minority status, limited health literacy, homelessness, incarceration history, lack of health insurance/coverage, noninjection drug use, depression, and recent HIV diagnosis were associated with unmet subjective or objective need for patient navigation. One in three PWH did not use patient navigation despite needing the service. Lack of knowledge about patient navigation was a barrier to use, calling for increased availability, and promotion of such services. PWH with social and economic vulnerabilities were less likely to get patient navigation when needed. It is important to address the question of how to make this service available to everyone who needs it.

Ignorance and Avoidance in EFL Written Production

This study focuses on cases where EFL students do not produce the required words and phrases in their written production (i.e. semantic nonuse). To the best of the researcher’s knowledge no quantitative studies have been conducted so far to show the magnitude and the various reasons of nonuse. To fill this gap, this study attempts to quantify and analyze such instances with examples. Data were collected from 71 Arabic-to-English translations dome by university English majors as one of the tasks of an introductory course in translation. They wrote an essay in Modern Standard Arabic at the beginning of the semester and translated it into English at the end of it. Cases of nonuse where students did not use any English words were categorized and analyzed. The students were consulted to justify such cases. Accordingly, three reasons of nonuse were identified: (1) ignorance and perceived difficulty (65%), (2) perceived redundancy (33%), and (3) memory lapse (2%). ‘Avoidance’ accounted for words and expressions that were not produced due to difficulty and redundancy. The distinction between ‘ignorance’ and ‘avoidance’ may give language instructors a deeper insight into the learners’ production problems and help them in planning strategy-based teaching. The findings may also help researchers classify and explain cases of nonuse more rigorously.

Contraceptive use in Appalachian women who use drugs and were recruited from rural jails

ABSTRACT This study describes a secondary data analysis of contraceptive use across the lifetime and within the six months prior to incarceration in a sample of 400 currently incarcerated women recruited from rural, Appalachian jails, who were using drugs prior to incarceration. Phase 1 (baseline) data from an NIH funded study were used to examine rates of contraceptive use, reasons for nonuse of condoms, and correlates of condom use. Results indicate that the majority (96.5%) of respondents reported lifetime use of contraceptives, and most (70.5%) had a history of using multiple methods, with male condoms, oral contraceptive pills, and contraceptive injections being the most commonly used methods. Almost 69% of respondents reported nonuse of contraceptives within the last six months, despite high rates of involvement in risky, intimate male partnerships prior to incarceration. Contraceptive use was found to be historically acceptable in this sample, in stark contrast to rates of use within the last six months prior to incarceration, suggesting that reproductive justice-informed, social work interventions to help improve current contraceptive use are warranted as a harm-reduction approach.