Provider Perspectives of Barriers to Contraceptive Access and Use among Women with Substance Use Disorders.

Autor: Charron E; Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah. Electronic address: betsy.charron@utah.edu., Tahsin F; Department of Political Science, Clemson University, Clemson, South Carolina., Balto R; University of Utah College of Nursing, Salt Lake City, Utah., Eichelberger KY; Prisma Health Upstate, Greenville, South Carolina., Dickes L; Department of Political Science, Clemson University, Clemson, South Carolina., Simonsen SE; University of Utah College of Nursing, Salt Lake City, Utah., Mayo RM; Department of Public Health Sciences, Clemson University, Clemson, South Carolina.
Jazyk: angličtina
Zdroj: Women's health issues : official publication of the Jacobs Institute of Women's Health [Womens Health Issues] 2022 Mar-Apr; Vol. 32 (2), pp. 165-172. Date of Electronic Publication: 2021 Dec 17.
DOI: 10.1016/j.whi.2021.11.010
Abstrakt: Objectives: Previous studies conducted from the patient perspective indicate that women with substance use disorders (SUDs) experience extensive barriers to contraceptive access and use (CAU), but there is limited research investigating this topic from the provider perspective. We explored provider perspectives on the barriers to CAU for women with SUDs. As a secondary objective, we highlighted provider contraceptive counseling strategies to address patient CAU barriers.
Methods: We conducted 24 qualitative interviews with a purposeful sample of women's health providers, including medical doctors, nurse practitioners, and certified nurse-midwives. We used thematic analysis to code the interviews with inductive codes and organized findings according to levels of influence within the Dahlgren and Whitehead rainbow model, a socioecological model of health.
Results: Provider-reported barriers to CAU were identified at four levels of socioecological influence and included reproductive misconceptions; active substance use; trauma, interpersonal violence, and reproductive coercion; limited social support; lack of housing, employment, health insurance, and transportation; stigma; discrimination; and punitive prenatal substance use policies and child welfare reporting requirements. Strategies for addressing CAU barriers mainly focused on patient-centered communication, including open information exchange, shared decision-making, and relationship building. However, providers described disproportionately highlighting the benefits of long-acting reversible contraception (LARC) and directing conversations toward LARC when they perceived that such methods would help patients to overcome adherence and other challenges related to active substance use or logistical barriers. Notably, there was no mention of CAU facilitators during the interviews.
Conclusions: Providers perceived that women with SUDs experience a range of CAU barriers, which they addressed within the clinical setting through use of both patient-centered communication and highlighting the benefits of LARC when they perceived that such methods would help clients to overcome barriers. Improving CAU for women with SUDs will require multidisciplinary, multipronged strategies that prioritize reproductive autonomy and are implemented across clinical, community, and policy settings.
(Copyright © 2021 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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