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

项目概要/摘要 因为大多数人在分娩后不久就恢复了性活动， 是实现健康生育间隔的关键。健康的生育间隔可以大大改善， 通过增加接受和继续使用非常 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，缺乏数据说明是什么知识和态度因素推动孕妇的意图 在出生后采取避孕措施。此外，并非所有有意采取避孕措施的人 产后最终能够在出生后对意图采取行动。目前尚不清楚具体环境 障碍使患者无法在产后接受所需的避孕措施。这项研究将填补证据空白 围绕产后避孕药具使用的驱动因素，实现以下目标： 避孕知识、态度、规范和自我效能感在驱动意向的启动中非常有效 产后避孕（VEC）。我们将在两个大型学术医疗中心招募怀孕患者， 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愿。目标2：描述环境障碍的影响 制定产后VEC启动计划使用顺序混合方法设计，我们将探讨如何 意图对产后VEC实际启动的影响因环境因素而异。定量数据将 从电子病历审查和12周产后患者调查中收集，以及 通过对在尝试发起一项倡议时面临重大障碍的选定参与者进行访谈获得的定性数据 产后避孕我们将进行正式的效应修正统计测试，以量化 环境因素改变了计划的VEC启动对实际启动的影响。定性访谈将 此外，还探索了患者体验、解释和应对环境的过程。 隔栏.这项研究是创新的，因为它在行为理论，前瞻性设计， 能够测试假设的行为-环境结果驱动因素和混合方法方法 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 将产生影响，因为研究结果将直接导致1）基于证据的方法的发展， 关于产后避孕的产前咨询，这将增加使用VEC的意愿，以及2） 建议在卫生系统一级采取干预措施， 产后病人的行为能力。结果将传播到奠定社区卫生 倡导者和临床领导者对人口健康的直接影响。

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.