Birth Control to Improve Birth Spacing (BIBS): a Prospective Longitudinal Cohort Study

项目摘要/摘要 因为大多数人在分娩后不久就会恢复性行为，所以持续使用有效的避孕措施 是实现健康生育间隔的关键。健康的生育间隔可以在 通过增加产后患者接受和继续使用VERVAL的比例来提高人口水平 出生后有效的避孕方法(包括任何典型使用失败率低于10%的方法)。 然而，关于是什么知识和态度因素驱动了孕妇的意图，缺乏数据 在出生后使用避孕药。此外，并不是所有形成避孕意图的人 产后最终能够在出生后按照这个意图行事。尚不清楚具体的环境是什么 障碍阻碍了患者在产后接受理想的避孕措施。这项研究将填补证据空白 围绕产后避孕药使用的驱动因素，实现以下目标：目标1：澄清 避孕知识、态度、规范和自我效能感对驾驶意向的启动非常有效 产后避孕(VEC)。我们将在两个大型学术医疗中心招收孕妇 医学和人口统计学上不同的患者，并通过基线调查询问他们有关因素 这会影响产后避孕的意向。目标2：描述环境壁垒的影响 关于制定意向的产后VEC启蒙。使用顺序混合方法设计，我们将探索如何 意图对产后实际血管内皮细胞启动的影响因环境因素而异。量化数据将 收集自电子病历审查和产后12周的患者调查，以及 通过对在尝试启动过程中面临重大障碍的选定参与者的采访，获得定性数据 产后避孕。我们将对效果修改进行正式的统计测试，以量化如何 环境因素改变了计划中的血管内皮细胞启动对实际启动的影响。定性访谈将 此外，还探讨患者体验、解释和应对环境的过程 障碍。这项研究具有创新性，因为它以行为理论为基础，前瞻性设计 实现对结果的假设行为环境驱动因素的测试，以及混合方法方法 制定未来的干预措施，通过增加健康的生育间隔来改善人口健康。这个项目 将是有影响的，因为调查结果将直接导致1)以证据为基础的方法的发展 关于产后避孕的产前咨询将增加使用VEC的意向，以及2) 建议在卫生系统一级采取干预措施，以改善阻碍健康的结构性障碍 产后患者根据这一意图采取行动的能力。结果将被传播到非社区健康领域 直接影响人群健康的倡导者和临床领导者。

Project Summary/Abstract Because most people return to sexual activity shortly after giving birth, consistent use of effective contraception is critical to achieving healthy birth spacing. Healthy birth spacing could be dramatically improved at the population level by increasing the proportion of postpartum patients who receive and continue use of very effective contraceptive methods (including any method with less than a 10% typical use failure rate) after birth. However, data are lacking regarding what knowledge and attitudinal factors drive pregnant people’s intention to use contraception after birth. Additionally, not all individuals who form an intention to use contraception postpartum end up being able to act on that intention after birth. It is unknown what specific environmental barriers prevent patients from receiving desired contraception postpartum. This study will fill the evidence gap around drivers of postpartum contraceptive use by achieving the following aims: Aim 1: Clarify the role of contraceptive knowledge, attitudes, norms, and self-efficacy in driving intention to initiate very effective contraception (VEC) postpartum. We will enroll pregnant patients at two large academic medical centers with medically and demographically diverse patients, and query them through a baseline survey regarding factors that influence intention to use contraception postpartum. Aim 2: Describe the impact of environmental barriers on enacting intended postpartum VEC initiation. Using a sequential mix-methods design, we will explore how the effect of intention on actual postpartum VEC initiation varies by environmental factors. Quantitative data will be collected from an electronic medical record review and a 12-week postpartum patient survey, and qualitative data through interviews of select participants who faced significant barriers in attempting to initiate postpartum contraception. We will conduct formal statistical tests of effect modification to quantify how environmental factors modify the effect of planned VEC initiation on actual initiation. Qualitative interviews will additionally explore the processes through which patients experience, interpret, and respond to environmental barriers. This study is innovative because of its novel grounding in behavioral theory, prospective design enabling testing of hypothesized behavioral-environmental drivers of outcomes, and mixed-methods approach to developing future interventions to improve population health by increasing healthy birth spacing. This project will be impactful because findings will lead directly to development of 1) an evidence-based approach to antenatal counseling about postpartum contraception that will increase intention to use VEC, and 2) recommendations for interventions at the health system level to ameliorate structural barriers that impede postpartum patients’ ability to act on that intention. Results will be disseminated to lay community health advocates and clinical leaders for immediate population health impact.