Womens Health Issues最新文献

{"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":"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":"Suicidal Ideation and Suicide Attempts Among Women Veterans Using VA Reproductive Health Care: Prevalence and Associations With Fertility-, Pregnancy- and Parenting-related Factors","authors":"Claire A. Hoffmire PhD ,&nbsp;Julie A. Kittel PhD ,&nbsp;Lisa A. Brenner PhD ,&nbsp;Alexandra L. Schneider BA ,&nbsp;Jodie Katon PhD ,&nbsp;Christin Miller MS ,&nbsp;Lindsey L. Monteith PhD","doi":"10.1016/j.whi.2024.06.004","DOIUrl":"10.1016/j.whi.2024.06.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Women veterans are at elevated risk for suicide and experience a high prevalence of suicidal ideation (SI) and suicide attempt (SA) history. Knowledge regarding SI/SA correlates among women veterans who use reproductive health care services is limited, inhibiting development of evidence-based, gender-sensitive suicide prevention programming tailored to meet women veterans’ needs and preferences. This study aimed to 1) describe the prevalence and characteristics of SI and SA among women veterans using Veterans Health Administration (VHA) reproductive health care services and 2) provide an initial exploration of associations between fertility-, pregnancy-, and parenting-related factors with SI and SA to guide future research.</p></div><div><h3>Methods</h3><p>Post-9/11 women veterans (<em>n</em> = 352) who used VHA reproductive health care in fiscal year 2018 completed a cross-sectional survey on reproductive health, mental health, and parenting.</p></div><div><h3>Results</h3><p>Approximately 30% and 12% experienced SI and SA(s), respectively, after military service; 10% reported past-month SI. Infertility, pregnancy loss, age at first pregnancy, and parental status were not significantly associated with SI or SA history, although notable effect sizes were observed for infertility and age at first pregnancy; further research is warranted. Among parents, parental functioning was not associated with SI/SA, but lower parental satisfaction was significantly associated with past-month SI (prevalence ratio, 3.36; 95% confidence interval, 1.19–9.46; adjusting for demographics, military characteristics, mental health symptoms).</p></div><div><h3>Conclusions</h3><p>Postmilitary SI and SA(s) are common among women veterans accessing VHA reproductive health care services. Those with low parental satisfaction may be at particularly high risk. Findings can guide future research and inform clinical care to facilitate suicide prevention.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 5","pages":"Pages 528-539"},"PeriodicalIF":2.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386724000604/pdfft?md5=1a7585562ff6073259e620f4bcd87374&pid=1-s2.0-S1049386724000604-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898654","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":"“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}

{"title":"Health Care Provider Willingness to Recommend Self-collected Tests for Human Papillomavirus: A Mixed Methods Examination of Associated Factors","authors":"","doi":"10.1016/j.whi.2024.05.005","DOIUrl":"10.1016/j.whi.2024.05.005","url":null,"abstract":"<div><h3>Introduction</h3><p>Cervical cancer disproportionately affects those who are underscreened. Human papillomavirus self-collection is a promising tool to expand screening.</p></div><div><h3>Objective</h3><p>Study objectives were to examine 1) factors (provider characteristics and practice type) associated with and 2) attitudes (perceived benefits and concerns) toward using human papillomavirus self-collection for cervical cancer screening in clinical practice.</p></div><div><h3>Methods</h3><p>This study had a mixed method design; prior to regulatory approval of self-collection, we conducted a national survey and interviews of health care providers who perform cervical cancer screening. Quantitative measures included provider and practice characteristics, willingness to recommend, and preferences related to self-collection. Qualitative interviews further elucidated provider perspectives.</p></div><div><h3>Results</h3><p>A total of 1,251 providers completed surveys, and 56 completed interviews. Among survey respondents, 33.4% reported they were likely to offer self-collection, 28.6% were unsure, and 38.0% reported they were unlikely. Most would offer self-collection either in the clinic or at home per patient preference. Male participants, advanced practice providers, internal and family physicians, and those practicing in academic medical center, hospital, or community health settings were more likely than female participants, obstetrician–gynecologist physicians, and those in private practice to indicate they were likely to offer self-collection. Concerns expressed in both surveys and interviews included the adequacy of sample collection and the ability to follow up. Respondents felt that self-collection would be particularly beneficial for those who did not have access to clinician-collected screening, as well as for patients who may have difficulty with pelvic examinations for any reason.</p></div><div><h3>Conclusion</h3><p>Providers considered human papillomavirus self-collection to be a way to expand access for patients with health care barriers and pelvic examination difficulties. They had concerns related to sample adequacy and follow-up after abnormal results.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 5","pages":"Pages 506-517"},"PeriodicalIF":2.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S104938672400046X/pdfft?md5=c5441a8749618b400d13b2c195289b1e&pid=1-s2.0-S104938672400046X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499241","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":"Development and Evaluation of a Novel Approach to Patient-Centered Contraceptive Counseling","authors":"Katharine O. White MD, MPH ,&nbsp;Kelly M. Treder MD, MPH ,&nbsp;Placidina Fico MPH ,&nbsp;Elizabeth Raskin MPH, MSW ,&nbsp;Natasha M. Lerner DrPH, MPA","doi":"10.1016/j.whi.2024.06.003","DOIUrl":"10.1016/j.whi.2024.06.003","url":null,"abstract":"<div><h3>Objectives</h3><p>We aimed to develop and evaluate a novel model, PHI CARE, that provides a standardized framework for shared decision-making in contraceptive counseling.</p></div><div><h3>Methods</h3><p>We developed the PHI CARE model with national experts, piloted it at three family planning clinics, and finalized it following additional patient and clinician review. We recruited pregnancy-capable people for an evaluation study via simulated contraceptive counseling and identified salient themes through inductive and deductive coding.</p></div><div><h3>Results</h3><p>Participants (<em>n</em> = 12) felt that counseling with the PHI CARE model was an improvement over previous counseling experiences and led to feelings of empowerment; participants did not feel pressured to decide about method use, felt in control during the conversation, and appreciated the absence of assumptions about their desires around pregnancy. Despite the standardized format, participants felt the counseling was individualized, “values-based,” and tailored to their preferences.</p></div><div><h3>Conclusion</h3><p>PHI CARE is a model to support clinicians and counselors in operationalizing the principles of shared decision-making in contraceptive counseling. Through standardization, PHI CARE allows for a more individualized experience for patients and addresses many critiques of traditional counseling.</p></div><div><h3>Practice Implications</h3><p>PHI CARE is a memorable, brief tool that can be used for patient-centered contraceptive counseling in any clinical encounter.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 5","pages":"Pages 473-479"},"PeriodicalIF":2.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386724000501/pdfft?md5=b6c737f0f4edf1eca622b2a7e3094126&pid=1-s2.0-S1049386724000501-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761704","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":"Health and Health Care Use of American Indian/Alaska Native Women Veterans: A Scoping Review","authors":"Mary K. Good PhD ,&nbsp;Heather Davila PhD ,&nbsp;Daniel Ball PhD ,&nbsp;Skye O'Neill MS ,&nbsp;Heather Healy MA, MLS ,&nbsp;Michelle A. Mengeling PhD","doi":"10.1016/j.whi.2024.07.003","DOIUrl":"10.1016/j.whi.2024.07.003","url":null,"abstract":"<div><h3>Background</h3><p>American Indian/Alaska Native (AI/AN) women serve in the U.S. military, use Veterans Health Administration (VA) health care, and reside in rural areas at the highest rates compared with other women veterans. However, little is known about their unique health care needs, access, and health care use.</p></div><div><h3>Objective</h3><p>We assessed the existing literature on the health and health care use of U.S. AI/AN women veterans.</p></div><div><h3>Methods</h3><p>Online databases were searched to identify studies. Study characteristics extracted included health care topic, study design, overall sample size and number of AI/AN women veterans, and funding source. We screened 1,508 publications for inclusion; 28 publications were ultimately retained.</p></div><div><h3>Results</h3><p>Health care access and use were the most common health care research topics (39%), followed by mental health (36%) and physical health (25%). Few studies considered the impact of rurality. Most studies found significant differences between AI/AN women veterans and other women veterans or AI/AN men veterans. Publication dates ranged from 1998 to 2023, with 71% published after 2010. The majority of studies (75%) were secondary analyses of extant health care data. More than three-quarters of studies (82%) were funded federally (e.g., VA). Many studies were based on VA administrative data, resulting in a gap in knowledge regarding AI/AN women veterans who are not eligible for, or choose not to use, VA health care.</p></div><div><h3>Conclusion</h3><p>Research to inform the health and health care of AI/AN women veterans is limited, especially in terms of known AI/AN and women veterans' prevalent health concerns (e.g., diabetes, hypertension), women's health and reproduction, and how AI/AN women veterans access, use, and confront barriers to health care. Moreover, there is scarce research specific to cultural, tribal, and regional factors that likely affect access and use of particular health care systems or that can affect perspectives on illness that impact long-term treatment adherence and patient outcomes.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 5","pages":"Pages 455-464"},"PeriodicalIF":2.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082193","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}