Evaluation of the London Measure of Unplanned Pregnancy in a United States population of women

Copyright @ 2012 Morof et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Objective: To evaluate the reliability and validity of the London Measure of Unplanned Pregnancy (a U.K.-developed measure of pregnancy intention), in English and Spanish translation, in a U.S. population of women. Methods: A psychometric evaluation study of the London Measure of Unplanned Pregnancy (LMUP), a six-item, self-completion paper measure was conducted with 346 women aged 15–45 who presented to San Francisco General Hospital for termination of pregnancy or antenatal care. Analyses of the two language versions were carried out separately. Reliability (internal consistency) was assessed using Cronbach’s alpha and item-total correlations. Test-retest reliability (stability) was assessed using weighted Kappa. Construct validity was assessed using principal components analysis and hypothesis testing. Results: Psychometric testing demonstrated that the LMUP was reliable and valid in both U.S. English (alpha = 0.78, all item-total correlations .0.20, weighted Kappa = 0.72, unidimensionality confirmed, hypotheses met) and Spanish translation (alpha = 0.84, all item-total correlations .0.20, weighted Kappa = 0.77, unidimensionality confirmed, hypotheses met). Conclusion: The LMUP was reliable and valid in U.S. English and Spanish translation and therefore may now be used with U.S. women.The study was funded by an anonymous donation

A qualitative analysis of approaches to contraceptive counseling.

ContextUnderuse and inconsistent use of contraceptives contribute to the continued high rate of unintended pregnancy in the United States. High-quality interaction between patient and provider about contraception is associated with improved contraceptive use, yet little is known about how providers support patients in the decision-making process.MethodsA random sample of 50 family planning visits by patients in the San Francisco Bay Area was selected from a larger sample of 342 audio-recorded visits to six clinics between 2009 and 2012. In qualitative analysis guided by grounded theory techniques, transcripts were assessed to determine counseling approaches and patterns in the use of these approaches.ResultsProviders employed three counseling approaches: foreclosed (in 48% of visits), characterized by discussion of few contraceptive methods and method selection by the patient with no involvement from the provider; informed choice (30%), characterized by detailed description of multiple methods, but little or no interaction between the patient and the provider; and shared decision making (22%), characterized by the provider's interactive and responsive participation with the patient in method selection. Use of these approaches varied by patient's age: Women 25 or younger experienced the foreclosed approach more often than older women, and patients older than 35 were far more likely than their younger counterparts to experience the shared decision-making approach.ConclusionsMost visits did not include interactive engagement between the patient and the provider. Contraceptive counseling interventions should encourage providers to responsively engage with patients of all ages to better meet their contraceptive needs

Health care providers' knowledge about contraceptive evidence: a barrier to quality family planning care? Contraception

Abstract Background: The underuse of effective contraceptive methods by women at risk for unintended pregnancy is a major factor contributing to the high rate of unintended pregnancy in the United States. As health care providers are important contributors to women's contraceptive use, this study was conducted to assess provider knowledge about contraception. Study Design: Bivariate and multivariate analyses were performed using data collected from a convenience sample of health care providers (physicians, nurse practitioners and physician assistants) at meetings of the professional societies of family medicine and obstetrics and gynecology. Results: Younger providers were more knowledgeable, as were obstetrician/gynecologists, female providers and providers who provide intrauterine contraception in their practice. Conclusions: The lack of consistent and accurate knowledge about contraception among providers has the potential to dramatically affect providers' ability to provide quality contraceptive care for their patients, which could have an impact on their ability to prevent unintended pregnancies

Understanding the role of race in abortion stigma in the United States: a systematic scoping review

The impact of abortion stigma is broad. Stigma impacts abortion providers, abortion patients, and the broader community. Understanding how race and culture affect aspects of abortion stigma may be an important piece of expanding access to and support of abortion. We conducted a systematic search for studies involving abortion stigma and race in PubMed, PubMed Central, Embase, PsycINFO, Sociological Abstracts, Social Services Abstracts, GenderWatch, and Ethnic NewsWatch on January 7, 2020. Articles were eligible for inclusion if they explored stigma and included participant race and/or ethnicity, were in English, and included original research. Thirty studies were included in the final review, including 11 quantitative studies, 9 qualitative studies, 4 mixed methods studies, and 6 dissertations. Most studies provided basic racial and demographic data but did not provide racial differences in experiences of abortion stigma. Three quantitative studies found that women of color had different experiences of abortion stigma compared to White women. Non-peer-reviewed studies of qualitative PhD-level dissertation research found that race, culture, religion, and immigration had unique and complex effects on abortion stigma experienced by Latinx women. While abortion stigma is common, we found that there is a lack of research contextualizing the racialization of the United States. Quantitative studies found that women of color experience abortion stigma at lower levels compared to White women. However, qualitative analyses of experiences suggest that quantitative measures of abortion stigma may not capture unique aspects of abortion stigma as experienced by women of color

Shared decision making in contraceptive counseling.

BackgroundShared decision making (SDM) is a potentially valuable but underexplored approach to contraceptive counseling.MethodsWe determined the correlation between patient report of SDM and of whether their provider had a method preference with measures of satisfaction.ResultsWomen reporting SDM were more likely to be satisfied with counseling than those reporting a provider-driven decision and were more likely to be satisfied with their method than those reporting a patient-driven decision. Patients who felt that the provider had a method preference were less likely to be satisfied with their method.ConclusionsSDM in contraceptive counseling is associated with patient satisfaction

Community-Engaged Curriculum Development in Sexual and Reproductive Health Equity: Structures and Self.

BackgroundInequitable outcomes in sexual and reproductive health disproportionately burden communities minoritized by systems of oppression. Although there is evidence linking structural determinants to these inequities, clinical learners have limited exposure to these topics in their training. We developed a curriculum aimed to teach clinical learners the structural determinants of sexual and reproductive health.MethodWe implemented Kern's six-step method for curriculum development. Through literature review, we identified structural competency as the foundational framework and explored community priorities for clinical training. We assessed learner needs regarding structural equity training, articulated goals and objectives, and chose video modules as the primary educational strategy. We collaboratively developed content with community scholars and reproductive justice advocates. For phase 1 of our curriculum, we created pillar videos with reflection questions, resources, and a visual glossary of key terms. All materials are available through an online educational platform offering open-access, evidence-based curricula.ExperienceWe launched our curriculum with a social media campaign and presented our videos at several national convenings. We implemented videos with clinical learners with positive preliminary evaluation results.ConclusionWith rigorous development rooted in community engagement, our curriculum contributes to the tools promoting structural equity training in obstetrics and gynecology

Women's preferences for contraceptive counseling and decision making

Abstract Background: Little is known about what women value in their interactions with family planning providers and in decision making about contraception. Study Design: We conducted semistructured interviews with 42 black, white and Latina patients. Transcripts were coded using modified grounded theory. Results: While women wanted control over the ultimate selection of a method, most also wanted their provider to participate in the decisionmaking process in a way that emphasized the women's values and preferences. Women desired an intimate, friend-like relationship with their providers and also wanted to receive comprehensive information about options, particularly about side effects. More black and Spanishspeaking Latinas, as compared to whites and English-speaking Latinas, felt that providers should only share their opinion if it is elicited by a patient or if they make their rationale clear to the patient. Conclusion: While, in the absence of medical contraindications, decision making about contraception has often been conceptualized as a woman's autonomous decision, our data indicate that providers of contraceptive counseling can participate in the decision-making process within limits. Differences in preferences seen by race/ethnicity illustrate one example of the importance of individualizing counseling to match women's preferences

Women's preferences for contraceptive counseling and decision making.

BackgroundLittle is known about what women value in their interactions with family planning providers and in decision making about contraception.Study designWe conducted semistructured interviews with 42 black, white and Latina patients. Transcripts were coded using modified grounded theory.ResultsWhile women wanted control over the ultimate selection of a method, most also wanted their provider to participate in the decision-making process in a way that emphasized the women's values and preferences. Women desired an intimate, friend-like relationship with their providers and also wanted to receive comprehensive information about options, particularly about side effects. More black and Spanish-speaking Latinas, as compared to whites and English-speaking Latinas, felt that providers should only share their opinion if it is elicited by a patient or if they make their rationale clear to the patient.ConclusionWhile, in the absence of medical contraindications, decision making about contraception has often been conceptualized as a woman's autonomous decision, our data indicate that providers of contraceptive counseling can participate in the decision-making process within limits. Differences in preferences seen by race/ethnicity illustrate one example of the importance of individualizing counseling to match women's preferences

Women's social communication about IUDs: a qualitative analysis.

ContextFew U.S. women use an IUD, despite the method's efficacy and ease of use. While studies have found that misconceptions about IUDs are prevalent, few have examined the influence of women's social networks on perceptions of the method.MethodsTwenty-four interviews and three focus groups (comprising 14 participants) were conducted in 2013 with a diverse sample of women aged 15-45 recruited from family planning clinics and the community in San Francisco. Half of participants had used IUDs. Women were asked about their social communication concerning contraceptives, particularly IUDs, and about the content of the information they had received or given. Transcripts were analyzed using a modified grounded theory approach to identify themes of interest.ResultsWomen reported that communication with female friends and family members was a valued means of obtaining information about contraceptives, and that negative information (which often was incorrect) was more prevalent and memorable than positive information in such communication. Women heard about negative experiences with IUDs from social contacts and television commercials; clinicians were a major source of positive information. Women who had never used IUDs expressed interest in learning about potential side effects and how IUDs feel, while users reported emphasizing to friends and family the method's efficacy and ease of use.ConclusionsMisinformation and negative information about IUDs are prevalent in social communication, and the information transmitted through social networks differs from the information never-users wish to receive. Findings support the creation of peer-led interventions to encourage IUD users to share positive personal experiences and evidence-based information