Enhancing uptake of preconception care services in family practice clinics using a patient centered screening tool: A Pilot Study
使用以患者为中心的筛查工具提高家庭诊所对孕前护理服务的采用:试点研究
基本信息
- 批准号:10736018
- 负责人:
- 金额:$ 15.35万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2023
- 资助国家:美国
- 起止时间:2023-09-22 至 2025-08-31
- 项目状态:未结题
- 来源:
- 关键词:AddressAdherenceAffectAgeBirthCaringChronicClinicConceptionsCounselingDataFamily PracticeFemaleFetusGoalsHealthHealth behavior changeHigh Risk WomanHigh-Risk PregnancyHypertensionIntentionInterviewJointsKnowledgeLearningMaternal HealthMaternal and Child HealthMedicalMethodsMidwestern United StatesMorbidity - disease rateMothersNational Institute of Child Health and Human DevelopmentOutcomeParticipantPatient SelectionPatient riskPatientsPerceptionPerinatologyPilot ProjectsPreconception CarePredictive FactorPregnancyPregnancy OutcomeQuestionnairesRandomizedRecommendationReportingResearchResearch PriorityRiskRisk AssessmentRisk FactorsScreening procedureSelf EfficacySeriesTestingTimeVisitWomanbehavior changecare systemschild bearingcompliance behaviordesignexperiencefollow-uphealthy pregnancyhealthy weightimprovedinnovationmortalitynovelpatient orientedpatient responsepressurepreventprimary care clinicprimary care providerprimary care settingreproductiverisk selectionscreeningtooluptakeurban setting
项目摘要
Project Summary
Women who make positive health behavior changes to protect their fetus typically do so after learning about
the pregnancy, unaware that the period of maximum sensitivity to these changes has passed. Fewer than half
of mothers enter pregnancy at a healthy weight and an increasing percentage of pregnancies are affected by
chronic hypertension and other chronic health conditions. These risk factors are predictive of poor birth
outcomes and increased risk to maternal health, yet they are difficult to modify after conception. Routine
preconception screening and counseling is recommended for all women of reproductive age, yet adherence is
low. More than sixteen years after the CDC recommended routine preconception screening and counseling in
primary care settings, fewer than one-fifth of primary care providers conduct this critical screening. Pioneering
approaches are needed to increase preconception screening and improve patient adherence to preconception
recommendations in primary care settings. Our innovative, self-selected preconception screening tool
encourages patients to be active participants in their own care and eliminates the time burden associated with
typical pre-selected screening. Typical pre-selected risk screening tools ask patients a series of predetermined
health-related questions to identify health risks. Pre-selected tools identify health information needs for the
patient, based on the patient’s response to the risk assessment. We propose a patient-selected screening tool,
whereby the patient selects from a list of preconception counseling topics based on her own perceived need
for information. This tool has fewer questions, reducing time burden.The first specific aim of this project is to
compare topics identified for counseling and overall identification of risk between the two screening
approaches. The second aim is to compare preconception knowledge, behavior change intention and self-
efficacy between patients who receive patient-selected and pre-selected preconception screening. The third
aim is to utilize a QUAN-qual sequential mixed methods design to explain quantitative results and identify
novel options for preconception counseling. To accomplish this objective, we will conduct a pilot study in a mid-
size primary care clinic located in a Midwest urban setting. Female patients of child-bearing age will be
randomly assigned to receive: 1) pre-selected preconception screening; 2) patient-selected preconception risk
screening; or 3) no screening. We will then invite participants to a follow-up interview. We will ask participants
about their experiences with the preconception tools and how we can better incorporate preconception
screening and counseling into primary care settings. The findings from the quantitative pilot study will be
integrated with the qualitative data using an explanatory sequential joint display. This project’s results can
demonstrate the relevance of utilizing a quicker and potentially more effective preconception screening tool for
improving maternal and child health.
项目摘要
做出积极的健康行为改变以保护胎儿的女性通常是在了解到
怀孕期间,没有意识到对这些变化的最敏感时期已经过去。不到一半
的母亲以健康的体重进入怀孕阶段,越来越多的怀孕受到
慢性高血压和其他慢性健康状况。这些危险因素预示着出生条件差。
结果和增加产妇健康的风险,但它们在受孕后很难改变。例程
建议对所有育龄妇女进行先入为主的筛查和咨询,但坚持
很低。在疾病预防控制中心推荐常规的早孕筛查和咨询16年后
在初级保健环境中,只有不到五分之一的初级保健提供者进行这项关键筛查。开拓性
需要采取措施来增加先入为主的筛查,并提高患者对先入为主的坚持。
初级保健环境中的建议。我们创新的、自行选择的先入为主的筛选工具
鼓励患者积极参与自己的护理,消除与以下方面相关的时间负担
典型的预选筛选。典型的预选风险筛查工具会询问患者一系列预先确定的
与健康相关的问题,以确定健康风险。预选工具可确定以下人员的健康信息需求
患者,基于患者对风险评估的反应。我们提出了一种患者选择的筛查工具,
由此患者基于她自己感知的需求从先入为主的咨询主题列表中进行选择
以获取信息。这个工具有更少的问题,减少了时间负担。这个项目的第一个具体目标是
比较两次筛查中确定的咨询主题和总体风险识别
接近了。第二个目标是比较前概念知识、行为改变意图和自我
接受患者选择和预先选择的先孕筛查的患者之间的疗效。第三
目的是利用定量序贯混合方法设计来解释定量结果和识别
先入为主的咨询的新选择。为达到这个目标,我们会在年中进行一项先导研究。
位于中西部城市环境的大型初级保健诊所。育龄女性患者将被
随机分配接受:1)预先选择的先孕筛查;2)患者选择的先孕风险
筛查;或3)不筛查。然后,我们将邀请参与者进行后续面试。我们将询问参与者
关于他们使用前置概念工具的经验,以及我们如何更好地融入前置概念
对初级保健环境进行筛查和咨询。量化试点研究的结果将是
使用说明性顺序联合显示与定性数据集成。这个项目的结果可以
展示使用更快且可能更有效的前概念筛选工具的相关性
改善妇幼健康。
项目成果
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