Emergency Contraception to Prevent Pregnancy: Missed Opportunities for Care.

描述（由申请人提供）：六分之一的美国妇女将在她的一生中被强奸，这可能导致怀孕，受伤，性传播感染，创伤后应激障碍，需要寻求法医和受害者服务，以及潜在的法律的系统参与安全和起诉（Tjaden & Thoennes，2006）。然而，关于计划B（R）的非处方药（OTC）状态如何影响与医疗保健提供者的联系，文献中存在空白，因为这种限制有可能影响完成强奸幸存者将获得的全面护理。这项混合方法研究的目的是检查非处方药计划B（R）对幸存者的影响，否则他们可能会接受金标准的全面护理。 女性主义的视角将构成本研究的框架。数据收集和分析计划是由PI的内容具体整合的护理模式，客户健康行为的互动模式和理论适合公共卫生现象，布朗芬布伦纳的生态系统理论。这一模式将指导使用并行混合方法，以实现以下具体目标：1）使用匿名调查来量化错过的期望护理机会，2）使用参与性行动框架和开放式问题来评估概念模式和袭击后计划B（R）用户对干预措施的愿望，以促进获得全面护理的所有要素。 我们将从密歇根州的大学药房招募参与者，同时他们正在获得计划B（R）。所有参与者将被要求回答一份匿名问卷。具体而言，所有参与计划B（R）的人都将填写一份名为“黄色问卷”的问卷，其中包括与妇女健康问题调查中的研究概念框架有关的问题。那些确定为完成强奸幸存者的人将回答“蓝色问卷”，其中包括性经历调查中的问题。 这项跨学科研究的结果将有助于深入了解PI模式在评估错失的护理机会方面的使用情况，并将有助于为使用计划B（R）的已完成强奸幸存者提供干预措施，这些幸存者有可能得不到全面的护理。该项目是一名博士生长期研究轨迹的第一步，重点是完成强奸幸存者、计划B（R）和有效的综合护理干预措施。 公共卫生相关性：现在，紧急避孕药（计划B（R））可以在药店买到，无需处方，强奸既遂的幸存者可以自我治疗，以防止怀孕，并放弃全面护理的其他五个要素：伤害护理、性传播感染预防、心理健康转诊、法医和受害者服务以及司法系统的参与。这项混合方法研究将量化潜在的错失护理机会，将深入了解PI模型在评估错失护理机会方面的使用，并将激发幸存者对替代全面护理的渴望。

DESCRIPTION (provided by applicant): One in six American women will be raped in her lifetime, which can result in pregnancy, injury, sexually transmitted infections, post-traumatic stress disorder, a need to seek forensic and victim services, and potential legal system involvement for safety and prosecution (Tjaden & Thoennes, 2006). However, there is a gap in the literature on how the over-the-counter (OTC) status of Plan B(R) may impact contact with a healthcare provider because such limitation has the potential to affect the comprehensive care completed rape survivors will receive. The purpose of this mixed method study is to examine the impact of OTC Plan B(R) on survivors who might otherwise receive gold standard comprehensive care. A feminist perspective will frame this study. The data collection and analysis plan are informed by the PI's content specific integration of a nursing model, the Interaction Model of Client Health Behavior and a theory suited to public health phenomena, Bronfenbrenner's Ecological Systems Theory. This model will guide the use of a concurrent mixed method approach to meet the specific aims of 1) using an anonymous survey to quantify missed opportunities for desired care and 2) using a participatory action framework and open-ended questions to assess the conceptual model and post-assault Plan B(R) users' desire for interventions to facilitate access to all elements of comprehensive care. We will recruit participants from university based pharmacies in Michigan while they are obtaining Plan B(R). All participants will be asked to answer an anonymous questionnaire. Specifically, all participants accessing Plan B(R) will complete a questionnaire labeled the "Yellow Questionnaire" which will include questions related to the study's conceptual framework taken from the Survey on Women's Health Issues. Those identifying as completed rape survivors will answer the "Blue Questionnaire" with questions from the Sexual Experiences Survey. The results of this interdisciplinary research study will provide insight into the use of the PI's mode in evaluating missed opportunities for care and will help inform interventions for completed rape survivors using Plan B(R) who are at risk of not receiving comprehensive care. This project is the initial step for a doctoral student in a long-term research trajectory focused on completed rape survivors, Plan B(R), and efficacious interventions for comprehensive care. PUBLIC HEALTH RELEVANCE: Now that emergency contraception (Plan B(R)) is available at the pharmacy without prescription, survivors of completed rape may self-treat to prevent pregnancy and forego the other five elements of comprehensive care: care for injuries, sexually transmitted infection prophylaxis, mental health referrals, forensic and victim services, and justice system involvement. This mixed method study will quantify potential missed opportunities for care, will provide insight into the use of the PI's model in evaluating missed opportunities fo care, and will elicit survivors' desires for alternative access to comprehensive care.