Transcript Natural Family Planning Project Paul G. Whittaker, Linda Hock-Long, Rebecca Merkh

Natural Family Planning
Project
Paul G. Whittaker, Linda Hock-Long,
Rebecca Merkh
Family Planning Council
Philadelphia, PA
Funded by US DHHS, Office of Population Affairs
1
Background
Family Planning Council
Title X grantee, SE Pennsylvania
26 agencies, 75 clinics
145,289 patients in 2007
49% Black, 32% White, 11% Hispanic
FPAR reports 0.16% (range 0-1.8%) use
‘natural methods’
2
Background
Findings from our OPA-funded study ‘Couples and
Contraceptive Practice’ suggested:
Many young adults believe condoms reduce
pleasure and intimacy
It is common for women to avoid or discontinue
hormonal methods due to access barriers or
problems with regimens and side effects
3
Background
Use of withdrawal was common among our young
adults (as an alternative to using barrier or
hormonal methods)
More than a third of both men and women used
withdrawal as their primary method of pregnancy
prevention for more than one month
4
Background
Participant quotes:
She said, “I can't be on the pill… I'm scared
because I already got the pill before and look
what it did to me.” So we started trying out the
pull out method.
She was not on the pill… It’s not something she
wants to put into her body. We tried to use
condoms… That didn’t really work. So I
switched to a combination of withdrawal and
rhythm.
5
Background
Use of empirically-based Natural Family Planning
(NFP) was not common among our young adults
One of 95 participants used an empirically-based NFP:
I feel comfortable with it now, because I’m used to it, and I
still haven’t gotten pregnant - learning about tracking your
ovulation, and the fertility awareness method was
educational. It helped me feel a little more secure …
knowing when to worry and when not to worry.
Withdrawal users may potentially be interested in
using empirically-based NFP
6
Consumers – Other Studies
Potential advantages of NFP:
Fertility unaffected
Lack of side effects
Leads to better understanding of reproductive physiology
Improved partner communication
Potential disadvantages of NFP:
Perception of high failure rates
Requires understanding of reproductive physiology
Needs sustained motivation, partner cooperation
Monitoring fertile period and using alternatives therein
7
Consumers - Other Studies
NFP methods most appropriate for women:
Willing and motivated to monitor fertile signs
Who accept potential for unintended pregnancy
With cultural beliefs for not using other
contraception
With regular cycles
8
Providers – Other Studies
Assumed that providers don’t recommend NFP
because they:
Overestimate complexity of use and failure rates
Underestimate ability of consumers to use NFP
Perceive difficulty in offering & supporting NFP
use
Believe increased NFP may lead to decreased use
of other more reliable methods
9
Project Aim 1
1)
Assess female Title X consumers’ knowledge,
attitudes & beliefs regarding NFP, plus
experiences, barriers & facilitators to NFP use.
Consumer Surveys (N=384)
Consumer Qualitative Interviews (N=20-60)
10
Conceptual Model
Theory of Planned Behavior (TPB).
Intention to use NFP determined by:




Attitudes (advantages/disadvantages)
Subjective norms (support/oppose)
Perceived behavioral control (easy/hard)
Background influences (age, education etc.)
11
Consumer Eligibility Criteria
Females
18-35 years of age
English-speaking
Established clinic patients (Survey only)
Have used NFP for a minimum of 3 consecutive
months in the past year (Interview only)
12
Consumer Recruitment
Consumer Survey
Participants will be recruited from Title X
clinics
Consumer Qualitative Interviews
Participants will be recruited from Title X
clinics and elsewhere in the community (e.g.
midwifery & doula practices, NFP training
programs)
13
Consumer Surveys
Will be administered at Title X clinics via ACASI
Domains will include:
Socio-demographics
Fertility history & perceived pregnancy risk
Pregnancy intentions & contraceptive use
Fertility knowledge
Awareness, knowledge, attitudes & experiences re: NFP
Provider interactions re: NFP
14
Consumer - Survey Assessment
Are consumers aware of NFP options?
Do they have enough reproductive health knowledge to
implement and correctly use NFP?
Do they use NFP? Why do they opt to use NFP? What
are the perceived barriers to NFP use?
What are socio-demographics of those who use NFP?
Do they discuss the use of NFP with family planning
providers? Do they think providers approve or
disapprove of NFP?
15
Consumer Interviews
Qualitative interviews will approximate a
natural conversation; participants will be
encouraged to share their experiences in their
own words
Probes will be used as needed to elicit further
information, seek clarification or shift topics
Interviews will be conducted until saturation is
reached (no new themes emerge from the data)
16
Consumer Interviews
Domains will include:
Childbearing desires & pregnancy intentions
Contraceptive beliefs, attitudes & history
Individual, social & environmental factors
influencing uptake & use of NFP
Perceived advantages & disadvantages of NFP
use
Perceived barriers & facilitators to NFP use
Perceived efficacy in using NFP
17
Consumer Interviews
Data :
Atlas.ti will be used to manage and analyze
interview data
Themes identified using framework analysis – a
priori concepts from conceptual model plus
grounded theory
18
Consumer - Interview Assessment
Do pregnancy intentions, past contraceptive
experiences, relationship status, partner attitudes, and
socio-demographics influence decisions to use NFP?
Do women find NFP to easy/hard to use?
What types of barriers do NFP users encounter? How
do they overcome these barriers?
What are the perceived advantages/disadvantages of
NFP use? How do advantages outweigh disadvantages?
Do women feel supported by their male partners and
providers in their use of NFP?
19
Project Aims 2 & 3
2) Assess Title X provider knowledge, attitudes &
beliefs regarding NFP, plus barriers/facilitators to
NFP service delivery.
Initial Provider Focus Groups (N=2)
Provider Surveys (N=225)
3) Identify potential strategies to reduce barriers to
consumer use of NFP uptake.
Follow Up Provider Focus Groups (N=2)
20
Title X Provider Eligibility Criteria
Family planning clinicians & counselors
providing direct care services
Have been employed at their respective
agency for more than 3 months
21
Initial Provider Focus Groups
6-12 participants per Focus Group (FG)
Will include individual free list exercises
and group discussion
FG discussion will explore provider
attitudes, beliefs & practices related to NFP
22
Provider Surveys
Will be completed by ~3 providers at each of 75
clinics
Paper and web-based versions will be available
Domains will include:
Socio-demographics
Knowledge, attitudes, beliefs & practice experiences
re: NFP
Perceived level of consumer experience with NFP
Perceived consumer interest in & eligibility for NFP
23
Providers – Our Assessment
Do providers routinely assess consumer correct use of
NFP? Does contraceptive counseling include a review of
NFP methods and provide guidance?
What is the congruence between provider estimates of
consumers’ NFP use and actual level of use?
What are provider level barriers/facilitators related to
the provision of NFP counseling services?
Do providers have the requisite knowledge and perceived
skills to deliver NFP counseling services?
Do providers view NFP as effective and appropriate
contraceptive options for their consumers?
24
Provider Follow Up FGs
6-12 participants per FG
Discussion will be organized around
findings in following areas:
Use of NFP by their consumers
Gaps in consumer knowledge of NFP
Providers own attitudes, knowledge and skills
in delivering counseling on NFP
25
Conclusion
This research will help us:
Identify facilitators & barriers to:
 Consumer uptake and successful use of NFP
 Delivery of NFP-related services
Identify individual, social and/or environmental
level (consumer & provider) strategies to
maximize facilitators and overcome barriers to
NFP uptake.
26