Judge-Golden, Colleen
(2019)
Patient-, Provider- and System-Level Factors Impacting Contraceptive Access and Use.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Contraception plays vital roles in promoting women’s health, quality of life and reproductive autonomy. The research described in this dissertation aimed to identify and evaluate factors at the patient, provider, and system levels that contribute to individuals’ abilities to access and use contraceptive methods in concordance with their goals and preferences. We assessed contraceptive preference matching and evaluated system-level policies and provider practices that directly impact access to specific methods, with a particular focus on the medically vulnerable population of women Veterans who use the Veterans Affairs (VA) healthcare system. First, we used a novel measure to investigate the extent to which women Veterans are currently using the contraceptive methods they consider to be “ideal,” and identified characteristics associated with ideal-current method match. Only 58% were currently using their stated ideal method, and match was reduced among non-white women and women with mental health disorders, suggestive of established health care disparities. However, qualitative analysis revealed that the bulk of reasons for ideal method non-use were personal and contextual, rather than resulting from access barriers. Our results underscore the complexity of contraceptive method selection and highlight enduring methodologic challenges of measuring contraceptive preferences. Next, we used decision analysis to estimate financial and reproductive health impacts to the VA healthcare system of a policy change to allow for twelve-month dispensing of oral contraceptive pills. We found that extended dispensing would better enable women Veterans to prevent unintended pregnancies, while also being economically feasible and sustainable for VA. These findings may help to inform evidence-based policy in VA. Finally, we conducted a cross-sectional survey study to evaluate provider-level adherence to best practice guidelines for provision of long-acting reversible contraception (LARC, i.e. intrauterine devices and contraceptive implants) in a single large healthcare system in Western Pennsylvania. We found substantial room for improvement in adherence to best practices, particularly same-day provision of these methods, and identified provider-reported barriers to best practice implementation, which were primarily logistical rather than stemming from knowledge deficits. These results may be used to inform efforts to expand access to LARC methods across this healthcare system.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
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| Date: |
24 August 2019 |
| Date Type: |
Publication |
| Defense Date: |
24 July 2019 |
| Approval Date: |
24 August 2019 |
| Submission Date: |
29 July 2019 |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Number of Pages: |
122 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Medicine > Clinical and Translational Science |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Contraception; women's health; health services; women Veterans |
| Date Deposited: |
25 Aug 2019 03:33 |
| Last Modified: |
25 Aug 2019 03:33 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/37229 |
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