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

通过节育来改善生育间隔（BIBS）：一项前瞻性纵向队列研究

• 批准号: 10452665
• 负责人: Elizabeth Janiak
• 金额: $ 22.77万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10452665
• 关键词: Academic Medical Centers; Address; Advocate; Affect; American College of Obstetricians and Gynecologists; Attitude; Automobile Driving; Baseline Surveys; Behavioral; Birth; Birth Intervals; Breast Feeding; Child; Child Welfare; Clinical; Community Health; Computerized Medical Record; Consent; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Counseling; Data; Development; Education; Enrollment; Environmental Impact; Environmental Risk Factor; Failure; Future; Health system; Healthy People 2020; Hormonal; Hospitals; Improve Access; Individual; Infrastructure; Institution; Insurance; Intention; Intervention; Interview; Intrauterine Devices; Knowledge; Lead; Longitudinal cohort study; Medical; Methods; Modification; Names; Outcome; Participant; Patients; Persons; Population; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Interval; Premature Birth; Process; Prospective Studies; Provider; Public Health; Quality of Care; Recommendation; Recovery; Reporting; Reproductive Health; Research; Role; Scientific Inquiry; Self Efficacy; Service delivery model; Services; Sex Behavior; Social Well-Being; Surveys; Testing; Time; Tubal Ligation; adverse outcome; antenatal; base; birth control; critical period; design; electronic data; evidence base; experience; follow-up; fourth trimester; improved; innovation; maternal outcome; neonatal death; neonatal outcome; novel; population health; postpartum contraception; pregnant; prevent; prospective; response; service delivery; social structure; theories; unintended pregnancy; uptake

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.

项目概要/摘要 由于大多数人在分娩后不久就会恢复性活动，因此坚持使用有效的避孕措施 对于实现健康的生育间隔至关重要。健康的生育间隔可以显着改善 通过增加接受并继续使用非常有效的产后患者的比例来提高人口水平 出生后有效的避孕方法（包括典型使用失败率低于 10% 的任何方法）。 然而，关于哪些知识和态度因素会影响怀孕者的意愿，目前还缺乏数据。 产后要采取避孕措施。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按照这个意图采取行动。具体环境如何尚不清楚 障碍阻止患者在产后接受所需的避孕措施。这项研究将填补证据空白 通过实现以下目标，围绕产后避孕药具使用的驱动因素： 目标 1：明确产​​后避孕药具的作用 避孕知识、态度、规范和自我效能感在推动意愿启动方面非常有效 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 医疗和人口统计上多样化的患者，并通过有关因素的基线调查向他们询问 影响产后使用避孕措施的意愿。目标 2：描述环境障碍的影响 制定预期的产后 VEC 启动。使用顺序混合方法设计，我们将探索如何 意图对实际产后 VEC 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 通过对在尝试启动时面临重大障碍的选定参与者进行访谈来获得定性数据 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 环境因素会改变计划的 VEC 启动对实际启动的影响。定性访谈将 此外还探讨了患者体验、解释和应对环境的过程 障碍。这项研究具有创新性，因为其新颖的行为理论基础、前瞻性设计 能够测试假设的结果行为环境驱动因素和混合方法 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 将会产生影响，因为研究结果将直接导致以下方面的发展：1）基于证据的方法 有关产后避孕的产前咨询将增加使用 VEC 的意愿，以及 2) 卫生系统层面的干预措施建议，以消除阻碍卫生系统发展的结构性障碍 产后患者按照该意图采取行动的能力。结果将传播给社区卫生人员 直接影响人口健康的倡导者和临床领导者。