2014 North American Forum on Family Planning

Last month, several of our Section faculty and staff traveled to Miami for the 2014 North American Forum on Family Planning.

The Forum gathered nearly 700 clinicians, researchers, and clinical staff to present, discuss, and learn the latest on family planning and how evidence can inform both policy and practice.

The agenda included daily panels covering sexual and reproductive health and justice issues. Section Chief Dr. Melissa Gilliam served on the panel, Addressing disparities in Family Planning: Why provider diversity matters. Dr. Gilliam also moderated a panel that covered Reproductive Justice, health disparities, and incarcerated women in the U.S  This session echoed our policy brief on this topic — that a right to abortion while behind bars is meaningless without access. As a panelist said, “What happens to women behind bars is a microcosm of the politicization of reproduction in our society.”

Dr. Gilliam also contributed to a timely and important discussion, The continuing debate on the Medicaid sterilization policy: The advocacy community’s perspective. This session took into account the full, diverse experiences of women seeking to end fertility and reminders to support reproductive autonomy.

Other Forum sessions from Section faculty included a presentation by Dr. Amy Whitaker called Postpartum IUD insertion: From research to reality.

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Dr. Sabrina Holmquist and Clinic Administrator Brie Anderson presented at the Ryan Program meeting.

 

Many of our faculty and staff had posters accepted at the Forum as well.

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Dr. Whitaker’s poster presented her research on motivational interviewing to improve post-abortive uptake of LARC methods. Dr. Whitaker’s research shows that motivational interviewing is a promising approach to address health behavior issues, including repeat abortion and contraceptive counseling, as it is theory based, directive, and patient centered. Click here to view a PDF of the poster.

 

Section faculty Dr. Julie Chor’s poster discussed her research on the prevalence and correlates of women presenting for abortion having a regular provider. julieforumDr. Chor’s study found that a history of abortion did not increase the likelihood of a woman having a regular  provider, and so an abortion visit is a good opportunity to engage women in the healthcare system. Click here to view a PDF of the poster.

 

Other posters presented at the Forum included:

  • Shared negative experiences with long-acting reversible contraception and their impact on contraception counseling: A mixed methods study (Authors include OBGYN resident Dr. Benjamin Brown and Dr. Amy Whitaker). Click here for PDF.
  • Risk Factors for Feelings of Shame and Guilt at the Time of Abortion (Authors include Dr. Julie Chor, Dr. Amy Whitaker, and Policy Coordinator Lee Hasselbacher). Click here for PDF.
  • Reproductive health characteristics associated with unwanted or ambivalent first sexual experience among reproductive-aged men in the United States: An analysis of the National Survey of Family Growth, 2006-2010 (Authors include Dr. Melissa Gilliam, Dr. Amy Whitaker, and former fellow Dr. Elisabeth Woodhams). Click here for PDF.
  • Also spotted: Is LARC for everyone? Socio-cultural perceptions and barriers to contraception among refugees in Ethiopia.  Dr. AuTumn Davidson conducted this research during her fellowship in family planning. Authors include Dr. Gilliam and Research Specialists Dr. Camille Fabiyi, Dr. Brandon Hill, and Erin Jaworski.

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New Section research assesses systematic barriers to IUD care

iudAt the Section of Family Planning & Contraceptive Research, we are committed to conducting quality research about the effectiveness of IUDs as birth control, especially for young women.

IUDs require little user maintenance, last between 7 and 12 years, and are highly effective at preventing pregnancy. As our earlier research has shown, in order to reduce undesired pregnancy amongst young women, it is critical to remove unnecessary barriers to choosing the IUD. One way to improve the quality of IUD services and the number of women receiving this contraceptive method is to assess the underlying problems that prevent women from receiving an IUD at their scheduled appointment.

Section Chief Dr. Melissa Gilliam’s research on these systematic barriers to IUD care was published in the July 2014 online edition of Contraception.

This article describes the novel use of a systematic approach to evaluating clinical care, called Failure Modes Effects and Criticality Analysis (FMECA). This step-by-step approach was originally developed by engineers to evaluate high-risk industries such as nuclear power and commercial aviation in order to identify practices that contribute to poor quality, unsafe, or unreliable inefficiencies. When adapted to healthcare, team members use FMECA to evaluate the systems and processes of a specific type of clinic care (eg IUD care). “Failures” are identified from qualitative and quantitative data, determining the frequency and impact in order to prioritize redesign and improvements.

For example, a failure in IUD delivery would be a patient calling and cancelling an appointment, but the cancellation is not entered into the scheduling system.

Dr. Gilliam’s study used the FMECA process to evaluate IUD services at three Title X clinics and identified three main failures during the scheduling and intake processes: 1) The patient does not show up for appointment or cancels; 2) The patient recently had unprotected intercourse; and 3) Limited time for counseling, informing, and placing IUDs. This FMECA drew upon interviews with IUD clients, the clinical care team, and reviewed administrative data at all three clinics.

After reviewing the failures, the researchers and clinical care team created solutions to the identified failures: implementing a revised scheduling call script and developing an app to be used in the waiting room. To address cancellations and no-shows, the new call center script reminded patients to keep their appointment or call to cancel beforehand. The script also addressed the need to abstain from unprotected intercourse prior to the appointment. The third failure, limited time, was also addressed by this revision, which identified potentially eligible IUD patients beforehand and saved time at the actual appointment. The barrier of limited time was also addressed with the waiting room “app”, which maximized the wait time by counseling women about contraceptive options.

After the completion of this study, the research team developed an online toolkit describing processes, procedures, and tools for an FMECA and shared with Title X clinics nationally.

To read our published research on the impact of the revised call script and the waiting room app, click here and here.

Clear communication during appointment scheduling can increase LARC uptake

Portrait of a female doctor using a computer while being on the phone

UPDATE: the final version of this article is now online. Read the abstract and download the full article in PDF format.

A new study from Dr. Melissa Gilliam and former Section staff discusses why some scheduled IUD appointments do not result in placement.

“Impact of a revised appointment scheduling script on IUD service delivery in three Title X family planning clinics” was published in the June 2014 online issue of Contraception.

This study began by reviewing clinic administrative data, which showed that women did not receive a desired IUD because of cancellations, no-shows, the need for an IUD-specific appointment, lack of awareness of clinic guidelines, and unknown pregnancy status.

With these systems-level barriers in mind, the researchers created a simple and scalable intervention: revising the appointment scheduling call script. The revised script used by telephone schedulers at a call center addressed these common mishaps and met national Title X guidelines. Along with the revised script, visual tools reminded schedulers to explain behavior prerequisites such as “Do not have unprotected sex at least two weeks prior to an appointment” and “Continue to use pills, patches, or rings up until the appointment”. The script also prompted schedulers to communicate logistical requirements such as bringing an ID, proof of insurance or cash to pay for the procedure, and instructions to call and cancel an appointment if necessary.

Before the new script was instituted, only 47 percent of patients at these sites successfully received an IUD at their scheduled appointment. After implementation of the revised script, 60 percent of scheduled appointments resulted in the desired IUD insertion. Additionally, the no-show rates decreased from 40 to 23 percent, and in particular, young women were more likely to keep their scheduled appointment.

This study shows that a simple IUD appointment scheduling script with clear communication improves LARC uptake. Additionally, as many clinics in the US move forward to computerized and centralized call centers, improving patient communication during the scheduling process may have a broad impact on clinical efficiency.

Related: Development and testing of an iOS waiting room “app” for contraceptive counseling in a Title X family planning clinic

 

Use of an iOS Waiting Room “App” Improves LARC Knowledge

image from www.securedgenetworks.comSection Chief and Ci3 Founder and Director Dr. Melissa Gilliam has published a research article in the American Journal of Obstetrics and Gynecology called Development and Testing of an iOS Waiting Room “App” for Contraceptive Counseling in a Title X Family Planning Clinic.

Data shows that long-acting reversible contraception (LARC) methods (the IUD and implant) are highly effective forms of contraception, but used by less than 10 percent of US women. After talking to clinic staff and analyzing appointment data at three Title X clinics in Chicago, this study found that a lack of contraceptive counseling during a scheduled appointment contributes to the under-use of LARC methods.

This study began by identifying key failures in IUD service delivery, including inadequate counseling time, non-use of waiting room pamphlets, and failure to counsel all women on LARC methods. As a result, the research team opted to create a counseling “app” to increase women’s contraceptive knowledge and interest in the most effective methods.

Results showed that users were highly satisfied with the app and it was easy to use. A brief (<15 min) app session significantly improved women’s knowledge scores on the relative effectiveness of LARC compared with other methods—before she even met with the healthcare provider. App testers (n=17) preferred the interactive, visually appealing design and video testimonials. In the pilot RCT (n=52), app users had significantly higher knowledge of contraceptive effectiveness (p=0.0001) and increased interest in the implant (7.1% to 32.1%, p=0.02) post-intervention. While app users reported increased interest in the contraceptive implant, the app had no discernible impact on women’s interest in the IUD.

The study concluded that integrating app usage into the Title X setting is highly acceptable, informative, and easily integrated into waiting room situations or downloaded onto smartphones in advance of a visit. Thus, apps could be a mechanism for implementing timely, evidenced-based educational information to a wide network of clinics and clients.

Reshaping Adolescent Sexual Health through Story Telling and Games

In the article From Intervention to Invitation: Reshaping Adolescent Sexual Health through Story Telling and Games, published in the African Journal of Reproductive Health, authors Melissa Gilliam, et al, from the Section of Family Planning and Contraceptive Research reviewed Game Changer Chicago. This project aims to reframe and retool adolescent sexual health education to focus on inviting rather than intervening with youth, which encourages self-empowerment that catalyzes increased awareness and self-efficacy. In addition to describing the Section’s ongoing work with sexuality education, technology and gaming, the article explores the project’s potential for successful implementation among youth in Africa.

Youth in both Chicago and Nigeria face disproportionately high rates of mortality and morbidity due to poor sexual and reproductive health. Game Changer Chicago is an initiative that incorporates digital storytelling, new media, and game design to conduct workshops with youth around issues of sexuality and emotional health. The intervention’s international, interdisciplinary team designed a series of workshops for teens to tell their stories in digital, “transmedia” formats.

Due to the positive feedback from youth participants, and the project’s promising potential to reach a wide audience online, the authors conclude that the program can continue to be successfully utilized and expanded by teens and adolescent reproductive health advocates in both domestic and international settings.