Patterns in Women's Unmet Sexual and Reproductive Healthcare Needs Over the Life Course

摘要 未得到满足的性和生殖保健(SRH)需求在美国是一个重大问题， 与一系列消极的性健康和生殖健康结果有关。因此，它是 必须了解与未得到满足的SRH需求相关的因素以及符合以下条件的妇女的特征 最容易受到未得到满足的SRH需求的影响。现有的研究在两个方面受到了限制。第一，量化研究 未得到满足的SRH需求往往受到缺乏关于未接受护理的妇女的现有信息的限制， 由于他们不在看护中心。其次，缺乏健壮的纵向数据使研究人员无法 能够具体说明SRH经历(和未满足的需求)在整个女性生活中是如何联系在一起的。 该项目的目标是阐明长期未得到满足的SRH需求与 确定与长期未满足的SRH需求水平相关的因素和差异。为此，这个项目 将利用来自个人对个人(P2P)健康访谈研究的创新混合方法数据集， 大型综合性健康研究，包括：(1)P2P中对育龄妇女的新深度访谈 样本(N=40)，(2)P2P样本中妇女的链接电子健康记录(EHR)(N=1,462)，以及(3) 关联的P2P调查数据。 为了实现总体目标，拟议的项目涉及两个具体目标。目标1：确定女性的 对他们一生中未得到满足的SRH需求的看法以及导致这些未得到满足的需求的条件 在学员EHR的指导下进行深度访谈。这些采访将引发女性对她们的叙事 随时间推移的SRH体验，并使用有关其社交网络的信息将其EHR中的SRH事件与情景联系起来 环境以及每种体验与后续SRH使用决策之间的联系。 此外，这些面谈将确定《电子健康记录》中未包括的未得到满足的需求和利用的实例。目标 2：使用序列分析对SRH使用随时间变化的模式进行分类，以比较(2a)因素和资源 与未得到满足的生殖健康需求和(B)生殖健康服务利用模式的社会人口差异有关。这就做 对照预防性护理和急性护理的标准以及妇女账户评估每个模式中的要素 他们的未得到满足的需求(聚集在目标1)，以评估未得到满足的需求水平。我会用多项式逻辑 检验(A)易感因素的衡量标准和扶持资源之间的关系的回归 (B)社会人口特征和 不同水平的未满足的SRH需求的SRH利用模式。这项研究的结果将产生有价值的 可用于制定有针对性的干预措施的信息，以减少未得到满足的SRH需求，消除种族和 性激素利用方面的社会经济差异，并改善性健康和生殖健康结果 女人的生活。

ABSTRACT Unmet sexual and reproductive healthcare (SRH) needs are a significant problem in the United States and are associated with a broad spectrum of negative sexual and reproductive health outcomes. Consequently, it is essential to understand the factors associated with unmet SRH needs and the characteristics of women who are most vulnerable to unmet SRH needs. Existing research has been limited in two ways. First, quantitative research on unmet SRH needs is often constrained by a lack of available information on women who do not receive care, by virtue of their absence from care. Second, the paucity of robust, longitudinal data has prohibited researchers’ ability to specify how SRH experiences (and unmet needs) are connected throughout women’s lives. The objective of this project is to elucidate the connection between unmet SRH needs over time and to identify the factors associated with and disparities in levels of unmet SRH needs over time. To do so, this project will leverage an innovative mixed-methods dataset from the Person to Person (P2P) Health Interview study, a large omnibus health study, including: (1) new in-depth interviews with reproductive-aged women in the P2P sample (N=40), (2) linked electronic health records (EHR) of women in the P2P sample (N=1,462), and (3) associated P2P survey data. To achieve the overall objective, the proposed project addresses two specific aims. Aim 1: Identify women’s perceptions of unmet SRH needs across their lives and the conditions that contribute to those unmet needs using in-depth interviews guided by participant’s EHR. These interviews will elicit women’s narratives of their experiences with SRH over time and contextualize SRH events in their EHR with information about their social circumstances and the connections between each experience and subsequent SRH utilization decisions. Furthermore, these interviews will identify instances of unmet need and utilization not included in the EHR. Aim 2: Classify patterns in SRH usage over time using sequence analysis to compare (2a) factors and resources associated with unmet SRH needs and (2b) sociodemographic disparities in patterns of SRH utilization. I will evaluate the elements in each pattern against standards of preventative and acute care and women’s accounts of their unmet needs (gathered in Aim 1) to assess the level of unmet need. I will use multinomial logistic regression to examine the association between (a) measures of predisposing factors and enabling resources (healthcare access, racism, trust in doctors, and social support), (b) sociodemographic characteristics and patterns of SRH utilization with differing levels of unmet SRH need. Results from this study will generate valuable information that can be used to develop targeted interventions to reduce unmet SRH needs, eliminate racial and socioeconomic disparities in SRH utilization, and improve sexual and reproductive health outcomes over women’s lives.