Contraception is the cornerstone of pregnancy prevention and the intrauterine device (IUD) is one of the most effective methods available. IUDs require little user maintenance, last between 7 and 12 years, and are more than 99 percent effective at preventing pregnancy. Thus, it is critical to remove unnecessary obstacles that prevent women from receiving a desired IUD.
The University of Chicago Section of Family Planning (the Section) has published three articles that discuss research on implementing interventions to the systematic barriers to IUD care. This research was funded by the Office of Population Affairs.
In collaboration with three Planned Parenthood of Illinois clinics, the research began with an in depth evaluation of all aspects of IUD service delivery called Failure Modes Effects and Criticality Analysis (FMECA). Health care providers and patients were interviewed to see the way in which the system could be redesigned to better deliver care. This step-by-stop process identified “failures” using qualitative and quantitative data, and determined the frequency and impact in order to prioritize redesign and improvements.
A systematic approach to improving intrauterine device services in family planning clinics appeared in Contraception. This publication outlines the Section’s analysis of the FMECA approach and identification of 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.
After reviewing the FMECA data, the research and clinical care teams created two solutions to the identified failures: implementing a revised scheduling call script, and developing an iOS counseling app to be used in the waiting room.
Impact of a revised appointment scheduling script on IUD service delivery in three Title X family planning clinics, also published in Contraception, discusses the implementation of the revised scheduling script.
Mindful of the systems-level barriers identified by the FMECA, Section researchers created a simple and scalable intervention: revising the appointment-scheduling call script. 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.
Through implementation of the revised script, no-show rates decreased from 40 to 23 percent, and in particular, young women were more likely to keep their scheduled appointment.
Development and Testing of an iOS Waiting Room “App” for Contraceptive Counseling in a Title X Family Planning Clinic, published in the American Journal of Obstetrics and Gynecology, describes the Section’s development and testing of a theory-based behavioral app. The app, developed with young women, features young women describing their contraceptive experiences. Testers were highly satisfied with the app and found it 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.
The Section continues to research the app for comprehensive contraceptive counseling.
The research team has also developed an online toolkit describing processes, procedures, and tools for an FMECA and shared with Title X clinics nationally.
For more about recent Section research and publications, visit familyplanning.uchicago.edu or our Sexual and Reproductive Health and Justice blog.
Special thanks to the Office of Population Affairs and Planned Parenthood of Illinois for their support.