Examining Contraceptive Use and Unmet Need Among Women Veterans

描述（由申请人提供）： 在美国，意外怀孕是一个普遍存在的问题，它对妇女及其子女的健康和社会造成了严重的不良后果。避孕是预防意外怀孕的一种非常有效的方法，避孕咨询和管理是育龄妇女初级保健的一个组成部分。育龄女性退伍军人的数量正在迅速增加，但我们对VA内避孕护理质量的信息很少。之前使用VA管理数据的研究表明，与美国女性人口相比，在VA接受护理的女性中避孕药具使用的普及率相当低。然而，由于行政数据无法提供有关妇女的性取向、性活动、怀孕意图或其伴侣的输精管结扎状况的信息，所有这些都可能影响避孕需求，因此无法准确评估这一人群中真正未满足的避孕需求。此外，行政数据无法准确地反映VA以外获得的方法，因此无法获得准确的避孕药具使用率。因此，我们建议进行一项研究，以评估VA内避孕药具的提供和使用的现状，并提供可行的调查结果，以提高女性退伍军人的避孕保健质量。拟议的项目是一项横断面、混合方法研究，涉及2,300名年龄在18-45岁之间的女性退伍军人，她们在过去12个月内在VA医疗保健系统内接受了初级保健。所有符合条件和登记的参与者将完成一项基于电话的定量调查。此外，将有目的地挑选大约200名参与者回答额外的开放式（定性）问题。为了确保我们能够听到避孕药具使用率最低的亚群体的观点，并询问似乎影响避孕药具使用率的关键患者和系统变量，定性部分的开始将推迟到数据收集的后半期，以便有足够的时间收集和审查定量调查数据，并相应调整定性抽样矩阵和访谈指南。这项研究的具体目的是审查避孕药具的使用模式（使用率，未满足的需求和意外怀孕率）在使用VA的女性退伍军人中进行初级保健（目标1）;确定女性退伍军人的哪些亚群特别容易意外怀孕（目标2）;并确定可改变的避孕使用的主要障碍和促进因素，以及这些障碍和促进因素在不同亚人群中的差异（目标3）。该提案将提供关于退伍军人妇女避孕药具提供和使用现状以及患者和系统因素如何影响避孕药具使用的关键第一证据。这种新的混合方法不仅可以了解哪些患者和系统因素具有统计学相关性，而且还可以了解它们可能为个别妇女产生良好或不良避孕结果的确切机制。因此，这项研究将产生临床上有意义的，以患者为中心的策略，以改善避孕保健和减少意外怀孕的风险，在不断增长的妇女育龄退伍军人的人口。

DESCRIPTION (provided by applicant): Unintended pregnancy is a prevalent problem in the U.S. that is associated with significant adverse health and social consequences for women and their children. Contraception is a highly effective way to prevent unintended pregnancy, and contraceptive counseling and management is an integral component of primary care for women of reproductive age. The number of female Veterans of reproductive age is rapidly increasing, yet we have very little information about the quality of contraceptive care within the VA. Prior research using VA administrative data suggests that the prevalence of contraceptive use among women receiving care in the VA is quite poor compared to the larger US female population. However, because administrative data cannot provide information about women's sexual orientation, sexual activity, pregnancy intention, or their partner's vasectomy status, all of which may obviate the need for contraception, the true unmet need for contraception in this population cannot be accurately assessed. Furthermore, administrative data cannot accurately capture methods obtained outside of the VA making it impossible to obtain accurate contraceptive use rates. Therefore, we propose to conduct a study to evaluate the current state of contraceptive provision and use within the VA and provide actionable findings to improve the quality of contraceptive care for women Veterans. The proposed project is a cross-sectional, mixed methods study with 2,300 female Veterans aged 18-45 years who have received primary care within the VA Healthcare System in the previous 12 months. All eligible and enrolled participants will complete a telephone-based quantitative survey. In addition, approximately 200 of the participants will be purposefully selected for additional open-ended (qualitative) questions. To ensure that we hear the perspectives from the subpopulations with the poorest contraceptive use and query about key patient and system variables that appear to impact contraceptive use, the start of the qualitative component will be delayed until the second half of data collection so that there is adequate time to collect and examine the quantitative survey data and adapt the qualitative sampling matrix and interview guide accordingly. The specific aims of this study are to examine contraceptive use patterns (prevalence of use, unmet need, and rate of unintended pregnancy) among women Veterans using the VA for primary care (Aim 1); determine which subpopulations of women Veterans are at particularly high risk for unintended pregnancy (Aim 2); and identify key modifiable barriers and facilitators to contraceptive use and how these vary across subpopulations (Aim 3). This proposal will provide critical first evidence on the current state of contraceptive provision and use among women Veterans and how patient and system factors impact contraceptive use. The novel mixed methods approach not only allows for an understanding of which patient and system factors are statistically relevant but also the precise mechanism through which they may produce good or poor contraceptive outcomes for individual women. Therefore, this study will generate clinically meaningful, patient-centered strategies to improve contraceptive care and decrease risk of unintended pregnancy in the growing population of women Veterans of childbearing age.