Womens Health Issues最新文献

{"title":"Development of a Maternal Health Toolkit for Emergency Department Education in Illinois","authors":"Katherine A. Craemer MPH ,&nbsp;Lauren Sayah MPH ,&nbsp;Emilie Glass MA ,&nbsp;Shirley Scott DNP ,&nbsp;Daniel R. Wachter MD, MPH ,&nbsp;Cara J. Bergo PhD, MPH ,&nbsp;Stacie E. Geller PhD, MPA","doi":"10.1016/j.whi.2024.08.001","DOIUrl":"10.1016/j.whi.2024.08.001","url":null,"abstract":"<div><h3>Background</h3><div>Most pregnancy-related deaths in Illinois are preventable. Many of those who died in recent years had at least one emergency department (ED) visit during pregnancy or the postpartum period. This suggests that with the proper training and education, EDs can play an important role in reducing maternal mortality.</div></div><div><h3>Methods</h3><div>A Task Force of 33 interdisciplinary stakeholders from across Illinois met monthly over 1 year to gather and develop educational content focused on obstetric emergency medicine and produce the Maternal Health Emergency Department Toolkit (Toolkit) training. A survey and listening session collected stakeholders’ feedback about factors that supported Toolkit development, barriers, and recommendations for similar projects.</div></div><div><h3>Results</h3><div>The Task Force members adapted existing tools and developed novel resources to fill the gaps in maternal health education for the ED setting. The Toolkit consists of five educational modules including didactic information, case-based learning, and resources for additional reading and local implementation. The modules focus on ED recommendations from the Illinois Maternal Mortality Review Committees, triage and management of emergencies in perinatal patients, screening and treatment of mental health and substance use conditions, addressing trauma, performing resuscitation during pregnancy, and conducting safe and coordinated discharge of perinatal patients from the ED. Task Force members described the inclusion of experts with interdisciplinary knowledge, working in small groups, and grounding the educational content in maternal health data as factors contributing to the project's success. They identified scheduling conflicts as a challenge and recommended future projects like this one include more ED providers and staff members.</div></div><div><h3>Conclusion</h3><div>Through promoting cross-disciplinary engagement, education, and collaboration with obstetrics and other service lines, the Toolkit can help fill the gaps in maternal ED education to decrease maternal mortality and morbidity in Illinois.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 6","pages":"Pages 553-561"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twelve-Month Sustainment of IPV Screening and Response Programs in Primary Care: Contextual Factors Impacting Implementation Success","authors":"Katherine M. Iverson PhD ,&nbsp;Julianne E. Brady MA ,&nbsp;Omonyêlé L. Adjognon ScM ,&nbsp;Kelly Stolzmann MS ,&nbsp;Melissa E. Dichter PhD, MSW ,&nbsp;LeAnn E. Bruce PhD, LCSW ,&nbsp;Galina A. Portnoy PhD ,&nbsp;Samina Iqbal MD ,&nbsp;Megan R. Gerber MD, MPH ,&nbsp;Sally G. Haskell MD ,&nbsp;Christopher J. Miller PhD","doi":"10.1016/j.whi.2024.07.001","DOIUrl":"10.1016/j.whi.2024.07.001","url":null,"abstract":"<div><h3>Purpose</h3><div>The Veterans Health Administration (VHA) employed implementation facilitation (IF) as a strategy to boost uptake of intimate partner violence (IPV) screening programs in primary care. This study examined the sustainment of screening uptake 1 year after IF and identified factors impacting sustainment success.</div></div><div><h3>Methods</h3><div>A mixed-methods evaluation using quantitative and qualitative data was conducted. IPV screening rates from the conclusion of the IF period (i.e., initial adoption) through the 1-year sustainment period served as the primary outcome. We categorized sites into four groups of screening adoption and sustainment success (high adoption and high sustainment, moderate adoption and moderate sustainment, low adoption and low sustainment, and no adoption and/or no sustainment). Qualitative analysis of key informant interviews was used to identify contextual factors affecting screening 12 months post-IF. A mixed sustainment analysis matrix integrated quantitative and qualitative findings and enabled the identification of cross-site patterns.</div></div><div><h3>Main Findings</h3><div>Seven of the nine sites sustained IPV screening at the most basic level (saw static or increased screening rates). High adopting and high sustaining sites (<em>n</em> = 3) were marked by consistently supportive medical center leadership, ongoing training for clinicians, clear protocols for responding to positive screens, and robust referral options for women experiencing IPV. Nonsustaining sites (<em>n</em> = 2) were marked by a host of barriers including staffing shortages, competing priorities, and inconsistent messaging from leadership regarding the importance of IPV screening.</div></div><div><h3>Conclusions</h3><div>Knowing barriers and facilitators to successful IPV screening sustainment can inform health care systems to tailor IF and other implementation strategies to sustain IPV screening in primary care. Sustainment of IPV screening requires attention to a combination of facilitators (e.g., consistent leadership support and robust referral options) as well as addressing key barriers (e.g., staff turnover and competing priorities).</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 6","pages":"Pages 617-627"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Mixed Methods Longitudinal Investigation of Maternal Depression Across the Perinatal Period Among Mothers Who Gave Birth During the COVID-19 Pandemic","authors":"Amy M. Claridge PhD ,&nbsp;Tishra Beeson DrPH","doi":"10.1016/j.whi.2024.09.005","DOIUrl":"10.1016/j.whi.2024.09.005","url":null,"abstract":"<div><h3>Background</h3><div>Depression during the perinatal period is associated with negative outcomes for both mothers and children, including higher rates of chronic depression in mothers and physical, emotional, and cognitive issues in children. This study aimed to determine how the stressors of the COVID-19 pandemic contributed to prenatal and postpartum depressive symptoms among a sample of peripartum mothers who gave birth during the pandemic. This study also examined risk factors for postpartum depression, including prenatal depressive symptoms, demographic characteristics, timing of birth during the pandemic, pregnancy intention, birth expectations and experiences, and pandemic-related concerns.</div></div><div><h3>Methods</h3><div>This mixed methods study included data from online surveys using a convenience sample of 284 expectant mothers with due dates from April 2020 to September 2021, and qualitative interviews with a subset of participants. Depressive symptoms and risk for clinical depression were assessed using the Edinburgh Postnatal Depression Scale during the third trimester of pregnancy and again within 8 weeks postpartum. Multiple regression models examined potential risk factors to determine which variables most predicted participants’ postpartum depressive symptoms and risk of clinical depression.</div></div><div><h3>Results</h3><div>Among this nonrepresentative, mostly white, and highly resourced sample, one-third of participants (33.8%) met the criteria for risk of clinical depression during the prenatal period, and 32.7% met this threshold in the postpartum period. Participants who reported higher levels of prenatal depressive symptoms, gave birth earlier in the pandemic, reported lower income, or had more pandemic-related concerns tended to report more postpartum depressive symptoms, adjusting for demographic characteristics and other variables of interest. Peripartum mothers who reported symptoms consistent with risk of clinical depression prenatally were almost four times more likely to screen positive for depression in the postpartum period, even after adjusting for other variables. In interviews, participants attributed negative emotions in pregnancy to uncertainty related to pandemic-related changes in care and expressed grief about missed pregnancy and postpartum experiences. In the postpartum period, some participants reported that their births were ultimately less stressful than anticipated.</div></div><div><h3>Conclusions</h3><div>Findings highlight the need for consistent and frequent depression screenings across the perinatal period, especially among participants who report depressive symptoms prenatally. Participants who gave birth early in the pandemic were at the highest risk of postpartum depression and may continue to need additional supports.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 6","pages":"Pages 605-616"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inequities in Adequacy of Prenatal Care and Shifts in Rural/Urban Differences Early in the COVID-19 Pandemic","authors":"Mounika Polavarapu PhD ,&nbsp;Shipra Singh PhD ,&nbsp;Camelia Arsene PhD ,&nbsp;Rachel Stanton OTR/L","doi":"10.1016/j.whi.2024.08.003","DOIUrl":"10.1016/j.whi.2024.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Adequate prenatal care is vital for positive maternal, fetal, and child health outcomes; however, differences in prenatal care utilization exist, particularly among rural populations. The COVID-19 pandemic accelerated the adoption of telehealth in prenatal care, but its impact on the adequacy of care remains unclear.</div></div><div><h3>Methods</h3><div>Using Pregnancy Risk Assessment Monitoring System (PRAMS) data, this study examined prenatal care adequacy during the early-pandemic year (2020) and pre-pandemic years (2016–2019) and investigated rural-urban inequities. Logistic regression models assessed the association between the pandemic year and prenatal care adequacy, and considered barriers to virtual care as a covariate.</div></div><div><h3>Results</h3><div>The sample consisted of 163,758 respondents in 2016–2019 and 42,314 respondents in 2020. Overall, the study participants were 12% less likely to receive adequate prenatal visits during the early-pandemic year (2020) compared with 2016–2019 (adjusted odds ratio [aOR] = 0.88; 95% confidence interval [CI] [0.86, 0.91]). Respondents in rural areas had lower odds of receiving adequate prenatal care compared with those in urban areas during both pre-pandemic years (aOR = 0.90; 95% CI [0.88, 0.93]) and the early-pandemic year (aOR = 0.94; 95% CI [0.88, 0.99]). However, after adjusting for barriers to virtual care, the difference between rural and urban areas in the early-pandemic year became nonsignificant (aOR = 0.93; 95% CI [0.78, 1.11]). Barriers to virtual care, including lack of phones, data, computers, internet access, and private space, were significantly associated with inadequate prenatal care.</div></div><div><h3>Conclusion</h3><div>During the early-pandemic year, PRAMS respondents experienced reduced adequacy of prenatal care. Although rural-urban inequities persisted, our results suggest that existing barriers to virtual care explained these inequities. Telehealth interventions that minimize these barriers could potentially enhance health care utilization among pregnant people.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 6","pages":"Pages 597-604"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Consumer Preferences for Pharmacy Provision of Mifepristone in the Human-centered Design Discovery Phase","authors":"Madeline Quasebarth MHS, MA ,&nbsp;Amanda Geppert PhD, MPH ,&nbsp;Qudsiyyah Shariyf ,&nbsp;Megan Jeyifo ,&nbsp;Amy Moore MSc ,&nbsp;Debra Stulberg MD ,&nbsp;Lee Hasselbacher JD","doi":"10.1016/j.whi.2024.09.003","DOIUrl":"10.1016/j.whi.2024.09.003","url":null,"abstract":"<div><h3>Objective</h3><div>We used human-centered design to explore preferred consumer experiences for obtaining mifepristone for medication abortion care from a pharmacy.</div></div><div><h3>Methods</h3><div>We conducted a two-part virtual workshop series with the same 10 participants in March and April of 2022 to initiate the discovery phase of a human-centered design process. Most participants were residents of Illinois and all participants had uteruses and had either sought abortion care or supported someone who had. Co-developed and co-facilitated with a local abortion fund, workshops engaged participants to provide formative data for the development of recommendations for community health center clinicians and pharmacists. A simulated medication abortion care counseling session grounded group activities and discussions that explored the experience of filling a medication abortion prescription at a pharmacy or by mail. Data were analyzed for key themes and recommendations. Qualitative data were collected from the workshops. Data analysis was conducted in three iterative, parallel stages: 1) virtual whiteboard results from both workshops were analyzed deductively through spreadsheets and visualizations; 2) close reading was conducted for workshop transcripts and participant evaluations; and 3) document analysis was used to triangulate data across formats. Data were discussed periodically among the research team until consensus was reached.</div></div><div><h3>Results</h3><div>Five primary categories of questions and preferences emerged from workshop data concerning: logistics, privacy, cost, pharmacist refusal, and follow-up care. Researchers found that participants desired certain questions and concerns to be answered by specific provider types. Participants indicated a desire for further research and opportunities that prioritize lived experience and use storytelling and/or design methods to collect data.</div></div><div><h3>Conclusions</h3><div>Despite existing patient-oriented medication abortion resources, there is a need for patient resources to support pharmacy dispensing, and a corresponding need for clinician and pharmacist resources. These can help in-person and mail-order pharmacy dispensing to be as consumer friendly as possible.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 6","pages":"Pages 580-588"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Insurance Type and Access to the Indian Health Service Before, During, and After Childbirth Among American Indian and Alaska Native People in the United States","authors":"Jessica L. Liddell PhD, MSW/MPH ,&nbsp;Julia D. Interrante PhD, MPH ,&nbsp;Emily C. Sheffield MPH ,&nbsp;Hailey A. Baker BS ,&nbsp;Katy B. Kozhimannil PhD, MPA","doi":"10.1016/j.whi.2024.08.002","DOIUrl":"10.1016/j.whi.2024.08.002","url":null,"abstract":"<div><h3>Background</h3><div>American Indian and Alaska Native (AI/AN) people in the United States face elevated childbirth-related risks when compared with non-Hispanic white people. Access to health care is a treaty right of many AI/AN people, often facilitated through the Indian Health Service (IHS), but many AI/AN people do not qualify for or cannot access IHS care and rely on health insurance coverage to access care in other facilities. Our goal was to describe health insurance coverage and access to IHS care before, during, and after childbirth for AI/AN birthing people in the United States.</div></div><div><h3>Methods</h3><div>We analyzed 2016 to 2020 Pregnancy Risk Assessment Monitoring System data (44 states and two other jurisdictions) for 102,860 postpartum individuals (12,920 AI/AN and 89,940 non-Hispanic white). We calculated weighted percentages, adjusted predicted probabilities, and percentage point differences for health care coverage (insurance type and IHS care) before, during, and after childbirth.</div></div><div><h3>Results</h3><div>Approximately 75% of AI/AN birthing people did not have IHS care around the time of childbirth. AI/AN people had greater variability in insurance coverage and more insurance churn (changes in type of insurance, including between coverage and no coverage) during the perinatal period, compared with non-Hispanic white people. Health care coverage differed for rural and urban AI/AN people, with rural AI/AN residents having the lowest prevalence of continuous insurance (60%).</div></div><div><h3>Conclusion</h3><div>AI/AN birthing people experience insurance churning and limited access to IHS care during the perinatal period. Efforts to improve care for AI/AN birthing people should engage federal, state, and tribal entities to ensure fulfillment of the trust responsibility of the United States and to address health inequities.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 6","pages":"Pages 562-571"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women's Health Care Delivery and Coordination After Transitioning From One Electronic Health Record to Another: Perspectives From Staff in the Veterans Health Administration.","authors":"Samantha K Benson, Zoe H Pleasure, Ann Guillory, Sharon K Gill, Kristen E Gray","doi":"10.1016/j.whi.2024.09.002","DOIUrl":"https://doi.org/10.1016/j.whi.2024.09.002","url":null,"abstract":"<p><strong>Objectives: </strong>The Veterans Health Administration (VA) is transitioning its 1,300 health care facilities from one electronic health record (EHR) to another. The transition aims to improve care delivery and interoperability; however, specific effects on women veterans, who comprise only 7.5% of the patient population, may be obscured without focused evaluation. We aimed to characterize the perspectives of VA staff regarding the impact of transitioning EHRs on women's health care delivery.</p><p><strong>Methods: </strong>We conducted semistructured interviews with VA staff members involved in delivering or coordinating care for women at three sites that had transitioned EHRs within the past year. Interviews were audio-recorded and transcribed. We used a rapid, templated qualitative analytic approach to identify salient themes in the data.</p><p><strong>Results: </strong>We interviewed 16 staff members across VA departments and roles. Although some participants felt the new EHR held promise, most identified challenges with the EHR rollout and implementation (e.g., insufficient training) and the EHR product (e.g., system inefficiencies and latency). Participants highlighted several ways the EHR transition disproportionately affected care delivery for women veterans, including via backlogs of community care referrals, insufficient opportunities for providers to gain proficiency with sex-specific workflows in the new EHR, and outdated listings for veterans who have changed their names. Participants reported that these issues affected their morale and contributed to decreases in productivity and delayed care.</p><p><strong>Conclusions: </strong>Many of our findings reflect challenges that affect VA staff broadly, whereas others may be compounded among women veterans and the VA staff who serve them. To achieve the goal of delivering timely, equitable, high-quality, comprehensive health care services to women veterans, continued efforts to monitor and address the impacts of the EHR transition on this population are needed.</p>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and Facilitators of Extended Use of the Contraceptive Implant: A Cross-Sectional Survey of Clinicians","authors":"","doi":"10.1016/j.whi.2024.04.003","DOIUrl":"10.1016/j.whi.2024.04.003","url":null,"abstract":"<div><h3>Background</h3><p><span>The U.S. Food and Drug Administration (FDA) approved the etonogestrel </span>contraceptive implant for 3 years of use. Evidence suggests that it may be used for up to 5 years for pregnancy prevention, also known as extended use.</p></div><div><h3>Methods</h3><p>We conducted a national cross-sectional survey among a group of reproductive health clinicians. We developed an online survey using the Consolidated Framework for Implementation Research (CFIR) and distributed it through e-mail listservs and social media groups from May to June 2021. We analyzed results using multivariable logistical regression.</p></div><div><h3>Results</h3><p>Among the 300 respondents, 195 (65.0%) reported that they always offer extended use, and 50 (16.7%) reported that they sometimes offer extended use. Fifty-five respondents (18.3%) reported that they never offer extended use. After adjusting for age, gender, and clinical setting, we found that complex family planning sub-specialists (adjusted odds ratio [aOR] = 9.32; 95% confidence interval [CI] [1.81, 48.03]) and family medicine<span><span> physicians (aOR = 4.37, 95% CI [1.58, 12.10]) were significantly more likely to recommend extended use compared with general obstetrics<span> and gynecology (OBGYN) physicians. Clinicians from private practices or health maintenance organizations were significantly less likely to offer extended use than those from academic centers (aOR = 0.19, 95% CI [0.07, 0.51]; aOR = 0.06, 95% CI [0.01, 0.31]). The most common barriers to offering extended use were concerns about </span></span>pregnancy risk, bleeding, and lack of FDA approval past 3 years. Meanwhile, clinicians identified strong published evidence supporting extended use as a key facilitator for offering it, and they perceived that prior counseling on extended use from a past clinician was a key facilitator for patients to adopt it.</span></p></div><div><h3>Conclusions</h3><p>One-third of clinicians in this study did not consistently offer extended use of the contraceptive implant. An opportunity exists to expand access to extended use by focusing on education interventions for clinicians and seeking FDA approval for 5 years of use.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 5","pages":"Pages 480-487"},"PeriodicalIF":2.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“It Feels Like Health Care with the Patient in Mind”: VA Patient and Staff Perspectives on Self-Collected HPV Testing","authors":"","doi":"10.1016/j.whi.2024.05.003","DOIUrl":"10.1016/j.whi.2024.05.003","url":null,"abstract":"<div><h3>Purpose</h3><p>Self-collected testing for human papillomavirus (HPV) is poised to transform cervical cancer screening. Self-tests demonstrate similar accuracy to clinician-collected tests, but for the half a million women served by the Veterans Health Administration (VA) and their clinicians, self-collected cervical cancer screening would be a new practice. We examined VA patient and staff perspectives to inform future implementation.</p></div><div><h3>Methods</h3><p>Semi-structured telephone interviews were conducted between 2021 and 2022 with female veterans receiving VA care (<em>n</em> = 22) and VA women's health nurses, clinicians, and administrators (<em>n</em> = 27). Interviews were audio-recorded and transcribed. Interview questions addressed knowledge and interest, potential advantages or disadvantages, and any questions participants had about self-collected screening. Responses were analyzed using rapid qualitative methods.</p></div><div><h3>Main findings</h3><p>Five overarching themes were identified. Both patients and staff indicated high interest and enthusiasm for self-collected HPV testing, tempered by questions about test accuracy and logistical considerations. Familiarity with self-testing for other conditions such as colon-cancer screening or COVID made self-collection seem like a simple, convenient option. However, self-testing was not viewed as a good fit for all patients, and concerns about lost opportunities or missed incidental lesions were raised. Patients and staff described challenges with pelvic examinations for patients with past sexual trauma, particularly in the male-dominated VA environment. Pelvic exams can leave patients feeling vulnerable and exposed; self-collected testing was seen as a mechanism for patient empowerment.</p></div><div><h3>Principal conclusions</h3><p>Veteran patients and VA staff shared common perspectives about potential advantages and disadvantages of self-collected HPV testing. Self-collected HPV testing has the potential to improve trauma-informed preventive health care for veterans.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 5","pages":"Pages 518-527"},"PeriodicalIF":2.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386724000446/pdfft?md5=859ea69136c221bbb70e7cf63f913078&pid=1-s2.0-S1049386724000446-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitators and Barriers to Medicaid Doula Benefit Implementation in California: Perspectives From Managed Care Plans and Risk-Bearing Organizations","authors":"","doi":"10.1016/j.whi.2024.05.006","DOIUrl":"10.1016/j.whi.2024.05.006","url":null,"abstract":"<div><h3>Introduction</h3><p>Medicaid coverage of doula services is increasing as a policy strategy to reduce maternal health inequities in the United States. However, early adopter states struggled to offer accessible, equitable Medicaid doula benefits when implementation began. California began covering doula services through its Medicaid program, Medi-Cal, in 2023. Managed care plans (MCPs) and risk-bearing organizations (RBOs) play an important role in ensuring pregnant and birthing people can access doula support through Medicaid benefits.</p></div><div><h3>Materials and Methods</h3><p>Between 2021 and 2022, we conducted 14 interviews with MCP and RBO staff (<em>n</em> = 20) representing a total of 14 MCPs and RBOs. Data were analyzed in two stages: 1) rapid assessment process and 2) using the Consolidated Framework for Implementation Research (CFIR) to identify specific facilitators and barriers to Medi-Cal doula benefit implementation.</p></div><div><h3>Results</h3><p>We identified 10 facilitators and 16 barriers across the five CFIR domains. Results indicate a general lack of familiarity with doula care and highlight the importance of relationship building with doulas and collaboration among plans.</p></div><div><h3>Conclusions</h3><p>In California, these findings can help guide improvements to emerging implementation challenges and evaluation efforts. Our findings can also help other states in the planning and Medicaid doula benefit design process.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 5","pages":"Pages 465-472"},"PeriodicalIF":2.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386724000471/pdfft?md5=9d7a53625590cddfd2184fab9b198f12&pid=1-s2.0-S1049386724000471-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}