Transcript Document

Natural Family Planning Use Among
Hispanic and African American
Young Adult Women:
Qualitative and Quantitative Approaches
January 14, 2008
Jennifer Manlove, PhD
Lina Guzman, PhD
Background
• Overall NFP use is low:
- 1-4% of all women use NFP each year
• Higher ever use of NFP:
- 12% of young adult women (18-29)
• Higher use among minorities
- Especially Hispanics and African Americans
• Failure rates:
- 3-5% with consistent and correct use
- 25% with typical use (user failure)
Gaps in Research
• Little is known about the who, why and when of
NFP use in the US
- Current measures may underestimate NFP use
- Little research has examined factors associated with
NFP use
- Information about NFP users’ knowledge, attitudes and
perceived benefits of NFP use is also limited
• Incomplete understanding of the effectiveness of
NFP use for preventing unintended pregnancy
Key Questions and Potential Problems
• Preliminary findings from Hispanic unmarried parents
suggests that many women equate “birth control” with
hormonal methods and underreport NFP use:
I: What about the withdrawal method? Did that come to mind
when you were thinking about birth control in this question?
R: No, I was thinking about something like, specific, like
medicines or something.
I: And why would you say that those two methods [rhythm
method and withdrawal] you don’t really consider as much as
the others?
R: Cause we’re not really doing anything really to prevent, the
fertilization of an egg. I mean when I think of birth control, I
think of like something, a product.
I: So when you heard the phrase birth control, what kind of
methods did you think of?
R: Um, the first one I thought of was the depo-provera
shot. When I think of birth control I think of something
permanent.
Key contributions
• We build on previous research by:
- Identifying multiple domains of influence on NFP (family,
individual, partner/couple and community)
- Examining knowledge, attitudes and perceptions about
NFP among young adult women and family planning
staff
- Assessing the effectiveness of NFP use compared with
no method and with other methods
Conceptual framework:
Behavioral model of health service use
Predisposing
Characteristics
Demographics
Age
Race/ethnicity
Immigrant
Relationship status
Previous children
Social Structure
Family structure
Parent education
Individual education
Attitudes/Beliefs/Knowledge
Cultural/religiousbeliefs
Knowledgere: family planning
Perceivedbarriers/facilitators
to NFP, hormonal methods
Family, peer, & partner beliefs
Enabling
Resources
Family/Individual
Insurance
Poverty status
Fundingfor services
& prescriptions
Community Resources
Presence ofaccessible/
affordable family
planning services
Culturally appropriate
programstaff
Awareness ofprograms
Perceived Need
for Services
Perceived/
Evaluated Need
Sexual activity
Perceptions of
pregnancy, STD risk
Partnerrisk-taking
Condom use
Hormonal method use
Use of
natural
family
planning
Study’s Three Stages
• Stage 1: 3 waves of one-on-one semistructured cognitive interviews
• Stage 2: Focus groups with program staff
and service providers
• Stage 3: Quantitative analysis
Qualitative Components:
Stages 1 & 2
Stage 1:
Key Research Questions
• What are the factors associated with the
use of NFP?
• How is knowledge about and perceptions
of NFP associated with use?
• What are predictors of successful NFP use
and factors associated with discontinuation
in use?
Stage 1: Qualitative Interviews
Study Design
Baseline Interviews
•
Collect data on predisposing characteristics,
enabling resources and perceived need
6-Month Follow-Up Interviews
•
Focus on short-term changes in contraception
methods, relationship and pregnancy status and
sexual activity.
12-Month Interviews
•
Focus on predictors of contraceptive success, (the
avoidance of an unplanned pregnancy)
Stage 1: Sample Design
• Target sample:
- Hispanic and African-American women using Title X funded
clinics in DC
- EVER used NFP
- Ages 18-29
Sample Design for Semi-Structure One-On-One Cognitive Interviews
a
Ever Use NFP incidence rate
Step 1: Number of Screener Interviews
Step 2: Number Potential Study Recruits Who Ever Used Identified
Step 3: Enrollment in Longitudinal Study, Assuming 80% Cooperation Rate
Step 4: Expected N for 6-Month Follow-up, Assuming 85% Retention Rate
Step 5: Expected N for 12-month Follow-up, Assuming 75% Retention Rate
a
Based on Child Trends analyses of NSFG data among women ages 18-29
Hispanics
African
Americans
Total
13.1%
500
66
53
45
34
13.4%
500
67
54
46
35
1000
133
108
92
69
Stage 1: Recruitment & Screening
•
Recruitment:
-
Building from current local contacts
Work with 2-3 local clinics
Anticipate recruitment will take at least 6 months
Key to success will be establishing strong partnerships and buy in
from program at all levels
-
•
Offering stipend to clinics;
Communicate potential benefits of study to clinics
Screening
-
High levels of screening to identify target population
Brief interview, easily administered by staff or research staff
Questions designed to identify the methods women are currently
using and those that have ever used NFP
Questions will seek to ensure that:
-
Target population is identified
Underreporting of NFP is minimized
Stage 1: Benefits of Qualitative Interviews
•
•
Sensitive and highly personal topics can best be
explored in a one-on-one interview
Semi-structured interviews:
-
-
•
Allow a thorough exploration of the respondent’s
thoughts, feelings, attitudes and behaviors
Ensure that key topics and issues are addressed
similarly for all participants
Provide greater flexibility than a structured interview to
pursue topics unique to the individual’s situation
Cognitive probes helpful in identifying target group
and better understanding complex topics (e.g. why
and when)
Stage 2: Focus Groups
Study Design
Research Question:
How are reproductive health decisions influenced by
enabling resources, in particular programs and
services?
Target Population:
Providers (e.g., program directors, nurses, doctors)
from programs and clinics in Washington, DC
Stage 2: Focus Groups
• Sample:
- 3-4 focus groups
- 8 to 10 participants per group (total 24-40)
- Group segmented by roles & responsibilities
- doctors and nurses
- program staff who meet directly with clients about
reproductive health
- program and clinic directors
• Content:
- Providers’ perceptions of NFP
- How prevalent is it use among its clients?
- Should NFP be offered as an option?
- Dissemination of information
- How often is information about NFP requested?
- Do they offer this information? Why or why not?
- Do they think it should be offered?
Stage 2: Benefits of Focus Groups
• Useful for providing insights based on group
interactions and assessing the extent to
which there is consensus on an issue
• Focus groups are more appropriate settings
for identifying barriers and facilitators to NFP
use from a program/service perspective
• Help identify and receive feedback on
recommendations for improving access to
NFP information
Quantitative Analysis:
Stage 3
Stage 3: Quantitative Analysis
Research Questions
• How are predisposing, enabling, and perceived
need factors are associated with NFP use
among young adult women?
• Do predictors of NFP use differ by
race/ethnicity?
• How is NFP use among young adult women
associated with unintended childbearing?
Stage 3: Quantitative Analysis
Data
• NSFG (2002 and forthcoming 2006-2008)
-
Cross-sectional
Over-samples Hispanics and African Americans
Measures of immigration, language status
Family planning providers
• National Longitudinal Study of Adolescent Health (Add
Health) (Wave III and upcoming Wave IV)
- Large, longitudinal sample (15,000+)
- Large Hispanic sample
- Measures unintended pregnancy
Stage 3: Dependent Variables
• NFP use
- Ever used NFP (NSFG)
- Used NFP in the past year (NSFG, Add Health)
- Contraceptive method (NSFG, Add Health)
• Unintended birth
- Unwanted birth or mistimed birth (Add Health)
Stage 3: Descriptive Information
(NSFG)
Table 2. Natural Family Planning Use by Young Adult
Women (18-29) in NSFG 2002
Total
12.0%
Race/ethnicity
Hispanic
13.1%
Black
13.4%
White
11.2%
Stage 3: Descriptive Information
(NSFG)
Table 2 cont. Natural Family Planning Use by Young
Adult Women (18-29) in NSFG 2002
Previous children
Has a child
13.5%
Has not had a child
10.6%
Marital/Union status
***
Married
15.2%
Cohabiting
7.3%
Outside a Union
10.8%
Stage 3: Predictors of NFP use
• Predisposing factors
- Socio-demographics (age, race/ethnicity, immigration)
- Family structure / marital/union status
- Reproductive health knowledge
• Enabling resources
- Insurance coverage, poverty level
- Publicly-supported family planning provider in county
• Perceived need for services
-
Sexual experience and activity
Characteristics of sexual partners and relationships
Attitudes about pregnancy, perceived STD risk
Other contraceptive methods
Stage 3: Analysis
• Bivariate and multivariate analyses
- Logistic regression (NFP use vs. no use;
unintended birth vs. no birth/intended birth)
- Multinomial logistic regression (NFP use vs. other
method use vs. no use)
- Interactions by race/ethnicity and immigrant status
Conclusion
• Three stages will inform each other and
provide a better understanding of the use of
NFP among young adult women
www.childtrends.org
www.childtrendsdatabank.org