Birth Control to Improve Birth Spacing (BIBS): a Prospective Longitudinal Cohort Study

通过节育来改善生育间隔（BIBS）：一项前瞻性纵向队列研究

• 批准号: 10452665
• 负责人: Elizabeth Janiak
• 金额: $ 22.77万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10452665
• 关键词: Academic Medical Centers; Address; Advocate; Affect; American College of Obstetricians and Gynecologists; Attitude; Automobile Driving; Baseline Surveys; Behavioral; Birth; Birth Intervals; Breast Feeding; Child; Child Welfare; Clinical; Community Health; Computerized Medical Record; Consent; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Counseling; Data; Development; Education; Enrollment; Environmental Impact; Environmental Risk Factor; Failure; Future; Health system; Healthy People 2020; Hormonal; Hospitals; Improve Access; Individual; Infrastructure; Institution; Insurance; Intention; Intervention; Interview; Intrauterine Devices; Knowledge; Lead; Longitudinal cohort study; Medical; Methods; Modification; Names; Outcome; Participant; Patients; Persons; Population; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Interval; Premature Birth; Process; Prospective Studies; Provider; Public Health; Quality of Care; Recommendation; Recovery; Reporting; Reproductive Health; Research; Role; Scientific Inquiry; Self Efficacy; Service delivery model; Services; Sex Behavior; Social Well-Being; Surveys; Testing; Time; Tubal Ligation; adverse outcome; antenatal; base; birth control; critical period; design; electronic data; evidence base; experience; follow-up; fourth trimester; improved; innovation; maternal outcome; neonatal death; neonatal outcome; novel; population health; postpartum contraception; pregnant; prevent; prospective; response; service delivery; social structure; theories; unintended pregnancy; uptake

Project Summary/Abstract Because most people return to sexual activity shortly after giving birth, consistent use of effective contraception is critical to achieving healthy birth spacing. Healthy birth spacing could be dramatically improved at the population level by increasing the proportion of postpartum patients who receive and continue use of very effective contraceptive methods (including any method with less than a 10% typical use failure rate) after birth. However, data are lacking regarding what knowledge and attitudinal factors drive pregnant people’s intention to use contraception after birth. Additionally, not all individuals who form an intention to use contraception postpartum end up being able to act on that intention after birth. It is unknown what specific environmental barriers prevent patients from receiving desired contraception postpartum. This study will fill the evidence gap around drivers of postpartum contraceptive use by achieving the following aims: Aim 1: Clarify the role of contraceptive knowledge, attitudes, norms, and self-efficacy in driving intention to initiate very effective contraception (VEC) postpartum. We will enroll pregnant patients at two large academic medical centers with medically and demographically diverse patients, and query them through a baseline survey regarding factors that influence intention to use contraception postpartum. Aim 2: Describe the impact of environmental barriers on enacting intended postpartum VEC initiation. Using a sequential mix-methods design, we will explore how the effect of intention on actual postpartum VEC initiation varies by environmental factors. Quantitative data will be collected from an electronic medical record review and a 12-week postpartum patient survey, and qualitative data through interviews of select participants who faced significant barriers in attempting to initiate postpartum contraception. We will conduct formal statistical tests of effect modification to quantify how environmental factors modify the effect of planned VEC initiation on actual initiation. Qualitative interviews will additionally explore the processes through which patients experience, interpret, and respond to environmental barriers. This study is innovative because of its novel grounding in behavioral theory, prospective design enabling testing of hypothesized behavioral-environmental drivers of outcomes, and mixed-methods approach to developing future interventions to improve population health by increasing healthy birth spacing. This project will be impactful because findings will lead directly to development of 1) an evidence-based approach to antenatal counseling about postpartum contraception that will increase intention to use VEC, and 2) recommendations for interventions at the health system level to ameliorate structural barriers that impede postpartum patients’ ability to act on that intention. Results will be disseminated to lay community health advocates and clinical leaders for immediate population health impact.

项目摘要/摘要 因为大多数人在分娩后不久就重返性活动，所以持续使用有效的违约 对于实现健康的出生间距至关重要。健康的出生间距可以大大改善 人口水平通过增加接受和继续使用的产后患者比例 出生后，有效的避孕方法（包括任何典型使用失败率少于10％的方法）。 但是，缺乏关于什么知识和态度因素推动孕妇的意图的数据 出生后使用避孕。另外，并非所有构成使用避孕的人的人 产后最终能够在出生后对此意图采取行动。尚不清楚哪种特定环境 障碍阻止患者接受所需的避孕产后。这项研究将填补证据差距 通过实现以下目的，围绕产后避孕药使用的驱动因素：目标1：阐明 避孕知识，吸引力，规范和自我效能激发意图以发挥非常有效的意图 避孕（VEC）产后。我们将在两个大型学术医疗中心注册孕妇 在医学和人口统计学上多样化的患者，并通过基线调查就因素进行查询 这种影响意图使用避孕产后。目标2：描述环境障碍的影响 关于制定预期的产后VEC启动。使用顺序混合方法设计，我们将探讨如何 意图对实际产后VEC倡议的影响因环境因素而异。定量数据将 可以从电子记录审查和12周的产后患者调查中收集，以及 定性数据通过访谈的访谈，这些参与者面临着重大障碍，试图启动 产后违规。我们将进行正式的效果修改统计测试，以量化 环境因素改变了计划的VEC倡议对实际计划的影响。定性访谈将 另外探索患者经历，解释和对环境反应的过程 障碍。这项研究具有创新性，因为其行为理论的新基础，前瞻性设计 实现结果的假设行为 - 环境驱动因素和混合方法方法 通过增加健康的出生间距来开发未来的干预措施以改善人口健康。这个项目 将会有影响力，因为发现将直接导致开发1）一种基于证据的方法 关于产后避孕的产前咨询，这将增加使用VEC的意图，而2） 在卫生系统层面上采取干预措施的建议，以改善阻碍结构障碍 产后患者对此意图采取行动的能力。结果将被传播以实行社区健康 提倡和临床领导者立即对人口健康的影响。