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

摘要 未满足的性和生殖保健（SRH）需求是美国的一个重大问题， 与广泛的负面性健康和生殖健康结果有关。根据该结果 对于了解与未满足的性健康和生殖健康需求相关的因素以及女性的特征至关重要 最容易受到性健康和生殖健康需求得不到满足的影响。现有的研究在两个方面受到限制。第一，定量研究 关于未满足的性健康和生殖健康需求的信息往往因缺乏关于得不到护理的妇女的信息而受到限制， 因为他们没有得到照顾。其次，缺乏可靠的纵向数据， 有能力具体说明性健康和生殖健康经历（和未满足的需求）如何在妇女的整个生活中相互关联。 该项目的目标是阐明长期未满足的性健康和生殖健康需求之间的联系， 查明与长期未满足的性健康和生殖健康需求水平相关的因素和差异。为此，该项目 将利用来自人对人（P2P）健康访谈研究的创新混合方法数据集， 一项大型综合健康研究，包括：（1）在P2P中对育龄妇女进行新的深入访谈 样本（N=40），（2）P2P样本中女性的链接电子健康记录（EHR）（N= 1，462），以及（3） 相关P2P调查数据。 为实现总体目标，拟议项目涉及两个具体目标。目标1：确定妇女的 对整个生活中未满足的性健康和生殖健康需求的看法以及造成这些未满足需求的条件 使用由参与者的EHR引导的深度访谈。这些采访将引出女性对她们的叙述， 随着时间的推移与SRH的经验，并在他们的EHR与他们的社会信息的背景下，SRH事件 在这方面，我们需要了解具体情况以及每次经历与随后的性健康和生殖健康利用决定之间的联系。 此外，这些访谈将确定未满足的需求和未包括在EHR中的使用情况。目的 2：使用序列分析对一段时间内SRH使用模式进行分类，以比较（2a）因素和资源 （a）与性健康和生殖健康需求未得到满足有关的性别差异;（b）在性健康和生殖健康利用模式方面的社会人口差异。我会 根据预防和紧急护理标准以及妇女的账户，评估每种模式中的要素 他们未满足的需求（目标1中收集的），以评估未满足需求的水平。我将使用多项式逻辑 回归分析，以检查（a）诱发因素和有利资源的措施之间的关联 （医疗保健的获得、种族主义、对医生的信任和社会支持），（B）社会人口特征和 性健康和生殖健康利用模式，未满足的性健康和生殖健康需求程度不同。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性健康和生殖健康需求，消除种族歧视， 性健康和生殖健康利用方面的社会经济差距，并改善性健康和生殖健康成果， 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.