ENGAGING CLINICIANS IN A PRE-IMPLEMENTATION ASSESSMENT OF THE WOMEN & PERSON-EMPOWERED COMMUNITY ACCESS FOR REPRODUCTIVE EQUITY (WE CARE) INTERVENTION

Objectives: To assess clinicians’ perspectives on WE CARE (an emergency department (ED) family planning counseling and referral intervention that uses an online health tool and community health workers) to inform intervention design for implementation. Methods: We conducted one-on-one, semi-structured interviews with Emergency Medicine, Family Medicine, and Obstetrics & Gynecology clinicians until thematic saturation. The Consolidated Framework for Implementation Research (CFIR) informed the interview guide and was used to code all transcripts. A CFIR expert conducted an external coding audit. Results: We interviewed 30 clinicians (female (77%), ED staff (47%), white (63%), and attending physicians (43%)). WE CARE was highly acceptable. Dominant CFIR domains include: (1) Clinicians suggested Design Quality and Packaging modifications, particularly the referral processes, to promote successful implementation; (2) transportation and insurance were essential Patient Needs and Resources; (3) WE CARE was Compatible with the Value of “no missed opportunity” to help patients; (4) Compatibility with Work Processes – WE CARE posed scheduling and reimbursement challenges to clinics; (5) Clinicians expressed concerns about an ED Culture of reproductive health frustrations, resistance to change, and competing priorities. Others identified the ED “safety net” culture and long wait times as assets to the intervention; (6) WE CARE had a significant Relative Advantage over the status quo. A few clinicians identified more advantageous alternatives (e.g., WE CARE in the clinic, home, or community settings); (7) Engaging Key Stakeholders throughout the hospital was a critical implementation element. Conclusions: Clinicians contextualized several implementation constructs relevant to designing and implementing an ED family planning intervention

Sociocultural Determinants of Teenage Childbearing Among Latinas in California

Objectives U.S. Latinas have a persistently high rate of teenage childbearing, which is associated with adverse outcomes for both mother and child. This study was designed to investigate the roles of socioeconomic factors and acculturation in teenage childbearing in this population. Methods Logistic regression was used to analyze the association of measures of acculturation (language spoken at home, nativity, and age at immigration) and respondents’ parents’ education with age at first birth in a stratified sample of post-partum women in California. Results The unadjusted odds ratio for teenage birth for Latinas versus non-Latina Whites was 5.2 (95% CI 4.1–6.6). Nativity was not significantly associated with teen birth, but speaking Spanish at home was positively associated and immigrating at a later age was negatively associated with teen birth. Overall, these measures of acculturation accounted for 17% (95% CI 8–28%) of the difference in odds of teen birth between Latinas and non-Latina Whites. Higher levels of education among respondents’ parents had differentially protective effects across the racial/ethnic groups. Controlling for disparities in respondents’ parents’ education without changing its differential effects across racial/ethnic groups reduced the odds ratio for Latinas compared to non-Latina Whites by 30% (95% CI 14–60%). Conclusion These findings call into question common assumptions about the protective effect of acculturation on teen fertility and suggest that improving childhood socioeconomic factors among Latinas may decrease teen childbearing

Contraceptive Counseling

Improving the quality of contraceptive counseling is one strategy to prevent unintended pregnancy. We identify aspects of relational and task-oriented communication in family planning care that can assist providers in meeting their patients' needs. Approaches to optimizing women's experiences of contraceptive counseling include working to develop a close, trusting relationship with patients and using a shared decision-making approach that focuses on eliciting and responding to patient preferences. Providing counseling about side effects and using strategies to promote contraceptive continuation and adherence can also help optimize women's use of contraception