集体影响方法：南卡罗来纳避孕措施获取倡议的经验教训

IF 2.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception Pub Date : 2025-10-13 DOI:10.1016/j.contraception.2025.111138

AJ Khoury, KE Beatty, LM Ventura, D Quesenberry, R Adelli, A Weber, MG Smith

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引用次数: 0

摘要

“选择好”是南卡罗来纳州的一项全州范围的避孕措施获取倡议，它采用了一个集体影响框架，通过合作、资金和基础设施支持来提高避孕措施的获取。本研究评估了在联邦合格医疗中心（FQHC）系统中实施“选择好”和项目受助人的领导和工作人员报告的促进因素、挑战和经验教训。本研究通过集体影响原则（共同议程、共享测量、相互加强的活动、持续沟通和骨干支持）检验了全州避孕药具获取倡议的实施情况，这是一项新颖的研究。方法在2022-2023年，即项目实施的最初六年结束时，与Choose Well工作人员（n=8）和FQHC管理人员/临床医生（n=19）进行了半结构化访谈，以探讨实施经验、促进因素和挑战。采用由集体影响框架指导的定性内容分析，对数据进行三角化，以整合两组的观点。结果成功实施的促进因素包括对获得避孕药具的共同愿景；转向避孕公平和扩大筹资模式；量身定制的临床级实施，并提供直接支持；通过合作伙伴会议和基于网络的培训、资源和协作沟通平台进行多渠道沟通；并对门诊工作流程和电子病历进行了增强，提高了工作效率。挑战包括共享测量开发的延迟、数据报告的可变性以及跟踪避孕服务指标的能力有限。fqhc内部的竞争优先级和员工流动进一步影响了共享测量和学习/改进机会。结论集体影响原则可以促进全州避孕措施的可及性。共享度量挑战需要对数据基础设施和培训进行投资。未来的倡议应强调双向沟通、灵活的实施战略和可持续的基础设施，以加强服务的提供。

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COLLECTIVE IMPACT APPROACH: LESSONS FROM SOUTH CAROLINA’S CONTRACEPTIVE ACCESS INITIATIVE

Objectives

Choose Well, a statewide contraceptive access initiative in South Carolina, adopted a collective impact framework to enhance contraceptive access through collaboration, funding, and infrastructure support. This study evaluates facilitators, challenges, and lessons learned reported by leadership and staff implementing Choose Well and program grantees in federally qualified health center (FQHC) systems. This study is novel in examining implementation of a statewide contraceptive access initiative through collective impact principles: common agenda, shared measurement, mutually reinforcing activities, continuous communication, and backbone support.

Methods

Semi-structured interviews were conducted in 2022-2023, at the end of the initial six years of program implementation, with Choose Well staff (n=8) and FQHC administrators/clinicians (n=19) to explore implementation experiences, facilitators, and challenges. Using qualitative content analysis guided by the collective impact framework, data were triangulated to integrate perspectives from both groups.

Results

Facilitators of successful implementation included a shared vision for contraceptive access; shift to contraceptive equity and an expanded funding model; tailored clinic-level implementation with direct support; multi-channel communication through partner convenings and a web-based platform for training, resources, and collaborative communication; and clinic workflow and electronic medical record enhancements to improve efficiency. Challenges included delays in shared measurement development, variability in data reporting, and limited capacity for tracking contraceptive service metrics. Competing priorities within FQHCs and staff turnover further impacted shared measurement and learning/improvement opportunities.

Conclusions

Collective impact principles can advance statewide contraceptive access initiatives. Shared measurement challenges require investments in data infrastructure and training. Future initiatives should emphasize bidirectional communication, flexible implementation strategies, and sustainable infrastructure to enhance service delivery.

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来源期刊

Contraception 医学-妇产科学

CiteScore

4.70

自引率

17.20%

发文量

211

审稿时长

69 days

期刊介绍： Contraception has an open access mirror journal Contraception: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal Contraception wishes to advance reproductive health through the rapid publication of the best and most interesting new scholarship regarding contraception and related fields such as abortion. The journal welcomes manuscripts from investigators working in the laboratory, clinical and social sciences, as well as public health and health professions education.