Addressing factors related to disparities in vasectomy

解决与输精管结扎术差异相关的因素

基本信息

批准号：
10734661
负责人：
SONYA B. BORRERO
金额：
$ 86.53万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
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：
2023-09-20 至 2028-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10734661
关键词：
Address Affect Age Age Years Black race Caring Child Communities Conflict (Psychology)Consultations Contraceptive Agents Contraceptive Usage Contraceptive methods Control Groups Data Decision Aid Decision Making Disparity Disparity population Ecosystem Ensure Equity Ethnic Origin Family Planning Female Sterilization Fertility Funding Goals Health Services Accessibility Health system Healthcare High-Income Populations Income Individual Intervention Interview Knowledge Latino Low income Male Contraceptive Agents Methods National Institute on Minority Health and Health Disparities Online Systems Outcome Pathway interactions Patients Pattern Persons Postpartum Period Poverty Pregnancy Pregnant Women Prenatal care Prevalence Procedures Race Randomized Randomized, Controlled Trials Reporting Reproductive Health Research Risk Sampling Services Sex Functioning Shapes Side Sterilization Surveys Testing Time United States Unwanted pregnancy Vasectomy Visit Woman Work cognitive interview design differences in access ethnic minority experience follow-up gender equity health equity improved innovation interest male medically underserved men men of color multidisciplinary novel novel strategies person centered prevent primary outcome prospective racial minority reproductive risk perception secondary outcome support tools tool web based decision aid

项目摘要

In the United States (US), the percentage of men who do not want more children increases from 43% among those between ages 25 to 34 years to 80% among men in their mid-30’s and early 40’s. Despite there being few differences in US men’s fertility intentions, Black, Latino and low-income men are more likely to be involved in unwanted pregnancies, which can contribute to the cycle of poverty among disadvantaged groups. Vasectomy (i.e., male permanent contraception) is the most effective male contraceptive method for those who do not want more children. Men of color and low-income men are far less likely to rely on vasectomy than White men and those with higher incomes, and these differences in use have persisted for decades. Vasectomy is also used less often than female sterilization in racial/ethnic minority and low-income communities, but use is more comparable to female sterilization among Whites and those with higher incomes. These uneven patterns of permanent contraception use may be related to racial/ethnic and income-based differences in access to knowledge about vasectomy and its (lack of) effect on sexual functioning. Yet, even with accurate and meaningful information, differences in vasectomy use may persist owing to unequal access to care, particularly among medically underserved men. There have been few efforts to comprehensively assess the individual demand- and healthcare supply-side factors that underlie differences in US men’s reliance on vasectomy, which hampers progress toward reproductive health equity. The proposed study seeks to address key individual-level determinants of disparities in vasectomy use - men’s knowledge and decisional conflict about the method - to ensure all men, regardless of race/ethnicity and income, are able to make informed, value-concordant decisions around contraception. Further, we will evaluate other facets of the healthcare ecosystem that may shape men’s access affordable and timely services. The specific aims of the study are to: 1) Build a patient-facing web-based decision aid to support high-quality vasectomy decisions; 2) Assess the impact of the decision aid on the quality of vasectomy decision making and interest in a randomized controlled trial with 750 men seeking information online about vasectomy or attending prenatal care or family planning visits in the US; and 3) Identify modifiable barriers to obtaining a desired vasectomy and strategies to address them by prospectively assessing men’s experiences accessing care at 2 and 6 months and conducting in-depth interviews. This innovative study offers a new approach to directly address racial/ethnic and income-based differences in vasectomy knowledge and access by producing a scalable tool designed to enhance men’s informed contraceptive decision making and care navigation. This study will also enable us to identify other potential strategies that can facilitate timely, equitable access to desired vasectomy services and advance gender equity in the work of preventing pregnancy at a time when options to terminate undesired pregnancies have narrowed drastically.

在美国，不想要更多孩子的男性比例从 43% 上升到年龄在 25 岁至 34 岁之间的人占 30 多岁和 40 岁出头的男性的 80%。美国男性的生育意愿差异不大，黑人、拉丁裔和低收入男性更有可能意外怀孕可能会加剧弱势群体的贫困循环。对于以下人群来说，输精管结扎术（即男性永久避孕）是最有效的男性避孕方法不想要更多孩子的有色人种男性和低收入男性比依赖输精管结扎术的可能性要小得多。白人和收入较高的人，这些使用差异已经持续了几十年。在少数族裔和低收入群体中，输精管结扎术的使用率也低于女性绝育术社区，但在白人和高收入群体中，使用情况与女性绝育更具可比性。永久性避孕药具使用的这些不均匀模式可能与种族/民族和基于收入的因素有关。然而，关于输精管切除术及其对性功能（缺乏）影响的了解存在差异。有了准确和有意义的信息，由于机会不平等，输精管结扎术的使用差异可能会持续存在医疗服务，尤其是医疗服务不足的男性，几乎没有做出全面的努力。评估构成美国男性差异的个人需求和医疗保健供给方因素对输精管结扎术的依赖阻碍了生殖健康公平的进展。解决输精管结扎术使用差异的关键个人层面决定因素——男性的知识和决策关于方法的冲突 - 确保所有男性，无论种族/民族和收入如何，都能够此外，我们还将评估避孕的其他方面。可能使男性获得负担得起且及时的服务的医疗保健生态系统的具体目标。研究目的是： 1) 构建面向患者的基于网络的决策辅助工具，以支持高质量的输精管切除术决策；评估决策辅助对输精管结扎术决策质量的影响以及对输精管结扎术的兴趣随机对照试验，750 名男性在网上寻求有关输精管结扎术或参加产前检查的信息在美国进行护理或计划生育就诊；以及 3) 确定获得所需输精管切除术的可改变的障碍以及通过前瞻性评估男性在 2 岁和 6 岁时获得护理的经历来解决这些问题的策略这项创新研究提供了一种直接解决问题的新方法。通过制作可扩展的工具，消除输精管结扎术知识和获取方面基于种族/民族和收入的差异这项研究还将旨在增强男性的知情避孕决策和护理导航。使我们能够确定其他可能的策略，以促进及时、公平地获得所需的输精管切除术在选择终止妊娠的情况下，服务和性别平等促进了预防怀孕工作的公平性意外怀孕已大幅减少。