Improving Methods and Measures of Reproductive Health Outcomes

改善生殖健康结果的方法和措施

• 批准号: 10159287
• 负责人: Kathryn L Kost
• 金额: $ 49.83万
• 依托单位: GUTTMACHER INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-05 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10159287
• 关键词: Address; Affect; Age; American; Area; Bayesian Analysis; Bayesian Method; Behavior; Belief; Characteristics; Client; Climate; Clinical; Conceptions; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Costs and Benefits; Counseling; Data; Data Sources; Demography; Development; Disease Outbreaks; Distal; Effectiveness; Environment; Failure; Fertility; Health Personnel; Healthcare; Individual; International; Internet; Investigation; Knowledge; Link; Location; Measurement; Measures; Methodology; Methods; Outcome; Patients; Perception; Policies; Policy Maker; Population; Population Group; Practice Guidelines; Pregnancy Rate; Provider; Reproductive Health; Research; Risk; Risk Estimate; Role; Structure; Subgroup; Surveys; Testing; Theoretical model; Time; United States; Update; Variant; Woman; Work; Zika Virus; abortion; base; design; experience; health organization; improved; innovation; knowledge base; men; novel; novel strategies; population based; pregnancy prevention; programs; public health priorities; public health research; reproductive; risk perception; socioeconomics; trait; unintended pregnancy; virtual

Project Summary Use of contraception for pregnancy prevention is among the most important behaviors affecting fertility in a population, and determining the trajectory of individual lives. But, contraceptive failures contribute to unintended, and often unwanted, conceptions. Almost all U.S. women use contraception at some point in their lives and millions of individuals rely on scientifically-valid estimates of the risk of failure. Clinicians also rely on these key measures to counsel clients in their choice of method as well as to establish broad practice guidelines with wide-reaching influence. And, because of the high quality of U.S. population data, contraceptive failure rates based on the experience of U.S. women are used in international research and policy applications. Indeed, few other products of demographic research are as widely used as contraceptive failure rates. In spite of their significance to public health and research, no new methodological advances have been offered in this area of work in almost 30 years and virtually no research exists to illuminate factors that account for variation in the risk of contraceptive failure across individuals, populations, locations or time. To address limitations of prior studies, improve the quality of failure rate estimates and forge a new path for research, we propose five linked aims. Aim 1 will advance understanding of factors that contribute to differential experiences with contraceptive failure by developing a novel theoretical framework specifically focused on individuals' perceptions, beliefs, relationships and external influences on the risk of contraceptive failure. We will exploit a wealth of existing qualitative data to inform development of the framework and then design and analyze new survey questions to test that framework in a large nationally representative survey of reproductive age women. In Aim 2, we will advance the measurement of contraceptive failure by developing a new approach for estimating failure rates using Bayesian statistics to more fully utilize existing knowledge and to surpass prior approaches that have limited our understanding of variation in failure rates across population groups. In Aim 3, we will use these new subgroup estimates to identify the factors that led to change over time in method- specific failure rates and the role of more effective use of contraception in recent declines in U.S. unintended pregnancy rates. This work has important implications not only for changes in the U.S. population, but could also inform new approaches to examining the impact of contraceptive use worldwide. In Aim 4, we expand our investigation to structural influences on contraceptive failure by examining the extent to which state policy climates and the socioeconomic characteristics of their residents are associated with variation in contraceptive failure for women who share similar demographic traits but live in different states. In Aim 5, we will work with an advisory panel of providers and leaders in reproductive health care to develop effective dissemination of a new set of contraceptive failure rates for clinical and public use.

项目概要 使用避孕措施预防怀孕是影响生育能力的最重要行为之一 人口，并决定个人的生活轨迹。但是，避孕失败会导致 无意识的、通常是不想要的概念。几乎所有美国女性都会在一生中的某个时刻采取避孕措施 数百万人的生命依赖于对失败风险的科学有效的估计。临床医生也依赖 关于这些关键措施，为客户选择方法提供咨询并建立广泛的实践 具有广泛影响力的指导方针。而且，由于美国人口数据的质量很高，避孕药具 基于美国妇女经验的失败率被用于国际研究和政策应用。 事实上，很少有其他人口统计研究产品能像避孕失败率那样得到如此广泛的应用。 尽管它们对公共卫生和研究具有重要意义，但尚未提供新的方法论进展 近 30 年来，人们对这一领域的工作进行了深入研究，但几乎没有任何研究能够阐明导致这一问题的因素。 不同个体、人群、地​​点或时间的避孕失败风险存在差异。致地址 先前研究的局限性，提高失败率估计的质量并开辟新的研究路径，我们 提出五个相互关联的目标。目标 1 将促进对导致差异的因素的理解 通过开发专门针对避孕失败的新颖理论框架来总结避孕失败的经验 个人的看法、信仰、关系和外部影响对避孕失败的风险。我们 将利用大量现有的定性数据为框架的开发提供信息，然后设计和 分析新的调查问题，以在一项全国性的大型生殖代表性调查中测试该框架 适龄妇女。在目标 2 中，我们将通过开发一种新方法来推进避孕失败的测量 使用贝叶斯统计估计故障率，以更充分地利用现有知识并超越 先前的方法限制了我们对不同人群失败率差异的理解。在 目标 3，我们将使用这些新的亚组估计来确定导致方法随时间变化的因素 - 具体失败率以及更有效地使用避孕措施在美国近期意外下降中的作用 怀孕率。这项工作不仅对美国人口的变化具有重要意义，而且可能 还为检查全球避孕药具使用影响的新方法提供了信息。在目标 4 中，我们扩展了 通过考察国家政策的程度来调查对避孕失败的结构性影响 气候及其居民的社会经济特征与避孕措施的变化有关 具有相似人口特征但生活在不同州的女性的失败。在目标 5 中，我们将与 由生殖保健提供者和领导者组成的咨询小组，旨在有效传播生殖保健 供临床和公众使用的新的避孕失败率。