“They're Doing Their Job”: Women’s Acceptance of Emergency Department Contraception Counseling

Caldwell, Martina T.; Hambrick, Nanci; Vallee, Phyllis; Thomas, Christian; Sutton, April; Daniels, Gwendolyn; Goyal, Nikhil; Manteuffel, Jacob; Joseph, Christine L.M.; Guetterman, Timothy C.

doi:10.1016/j.annemergmed.2019.10.014

Cited by 5 publications

(6 citation statements)

References 31 publications

(35 reference statements)

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“…However, the participants who were not accepting of contraception counseling felt that contraception is a sensitive topic, and the ED is an inappropriate setting to receive contraception counseling. 25 While this study further supports the ED as a setting for contraception services, it highlights the need for patient-centered, targeted approaches to EDbased contraception services. Future research should explore these factors further.…”

Section: Discussionmentioning

confidence: 66%

Acceptability of Contraceptive Services in the Emergency Department: A Cross-sectional Survey

Alexander¹,

Chernoby²,

VanderVinne³

et al. 2021

WJEM

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Introduction Unintended pregnancy disproportionately affects marginalized populations and has significant negative health and financial impacts on women, their families, and society. The emergency department (ED) is a promising alternative setting to increase access to sexual and reproductive health (SRH) services including contraception, especially among marginalized populations. The primary objective of this study was to determine the extent to which adult women of childbearing age who present to the ED would be receptive to receiving contraception and/or information about contraception in the ED. As a secondary objective, we sought to identify the barriers faced in attempting to obtain SRH care in the past. Methods We conducted a quantitative, cross-sectional, assisted, in-person survey of women aged 18–50 in the ED setting at two large, urban, academic EDs between June 2018–September 2019. The survey was approved by the institutional review board. Survey items included demographics, interest in contraception initiation and/or receiving information about contraception in the ED, desire to conceive, prior SRH care utilization, and barriers to SRH. Results A total of 505 patients participated in the survey. Participants were predominantly single and Black, with a mean age of 31 years, and reporting not wanting to become pregnant in the next year. Of those participants, 55.2% (n = 279) stated they would be interested in receiving information about birth control AND receiving birth control in the ED if it were available. Of those who reported the ability to get pregnant, and not desiring pregnancy in the next year (n = 279, 55.2%), 32.6% were not currently using anything to prevent pregnancy (n = 91). Only 10.5% of participants stated they had experienced barriers to SRH care in the past (n = 53). Participants who experienced barriers to SRH reported higher interest in receiving information and birth control in the ED (74%, n = 39) compared to those who had not experienced barriers (53%, n = 240); (P = 0.004, 95% confidence interval, 1.30–4.66). Conclusion The majority of women of childbearing age indicated the desire to access contraception services in the ED setting. This finding suggests favorable patient acceptability for an implementation study of contraception services in emergency care.

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Section: Discussionmentioning

confidence: 66%

Acceptability of Contraceptive Services in the Emergency Department: A Cross-sectional Survey

Alexander¹,

Chernoby²,

VanderVinne³

et al. 2021

WJEM

View full text Add to dashboard Cite

show abstract

“…This ongoing discussion regarding the degree to which ED HCPs should provide preventive care beyond typical emergency management has been debated previously on such topics as vaccination delivery and contraception provision. 24,25 Stage 2, the act of having the confidential conversation, was influenced by several factors, the most salient of which being perception of parents and HCP self-efficacy. The HCP perception of the parent's opposing reaction to the conversation often impeded its occurrence.…”

Section: Discussionmentioning

confidence: 99%

“…HCPs who viewed confidential conversations about sensitive conditions as part of their professional mission created time and space for them to occur despite the busy and sometimes overwhelming ED environment. This ongoing discussion regarding the degree to which ED HCPs should provide preventive care beyond typical emergency management has been debated previously on such topics as vaccination delivery and contraception provision 24,25 . Stage 2, the act of having the confidential conversation, was influenced by several factors, the most salient of which being perception of parents and HCP self‐efficacy.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing the conduction of confidential conversations with adolescents in the emergency department: A multicenter, qualitative analysis

Chernick

Bugaighis

Britton

et al. 2023

Academic Emergency Medicine

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Background Health care providers (HCPs) in the emergency department (ED) frequently must decide whether to conduct or forego confidential conversations with adolescent patients about sensitive topics, such as those related to mental health, substance use, and sexual and reproductive health. The objective of this multicenter qualitative analysis was to identify factors that influence the conduct of confidential conversations with adolescent patients in the ED. Methods In this qualitative study, we conducted semistructured interviews of ED HCPs from five academic, pediatric EDs in distinct geographic regions. We purposively sampled HCPs across gender, professional title, and professional experience. We used the Theoretical Domains Framework (TDF) to develop an interview guide to assess individual and system‐level factors affecting HCP behavior regarding the conduct of confidential conversations with adolescents. Enrollment continued until we reached saturation. Interviews were recorded, transcribed, and coded by three investigators based on thematic analysis. We used the coded transcripts to collaboratively generate belief statements, which are first‐person statements that reflect shared perspectives. Results We conducted 38 interviews (18 physicians, 11 registered nurses, five nurse practitioners, and four physician assistants). We generated 17 belief statements across nine TDF domains. Predominant influences on having confidential conversations included self‐efficacy in speaking with adolescents alone, wanting to address sexual health complaints, maintaining patient flow, experiencing parental resistance and limited space, and having inadequate resources to address patient concerns and personal preconceptions about patients. Perspectives divided between wanting to provide focused medical care related only to their chief complaint versus self‐identifying as a holistic medical HCP. Conclusions The factors influencing the conduct of confidential conversations included multiple TDF domains, elucidating how numerous intersecting factors influence whether ED HCPs address sensitive adolescent health needs. These data suggest methods to enhance and facilitate confidential conversations when deemed appropriate in the care of adolescents in the ED.

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“…38 Residency programs can also look upon the safety-net experiences as an opportunity for innovation. For example, Caldwell et al 39 examined the acceptability of ED interventions to improve access to family planning services. The challenges faced in safety-net hospitals could be an opportunity for residency programs to consider the value of developing career tracks that promote advocacy and local engagement with the community to improve health care delivery and health outcomes.…”

Section: Training Influences Clinical Preparation and Willingness To Work In Underserved Areasmentioning

confidence: 99%

Untold stories: Emergency medicine residents’ experiences caring for diverse patient populations

Haggins

Clery

Ahn

et al. 2021

AEM Education and Training

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ObjectivesThe Accreditation Council for Graduate Medical Education expects specialties to teach and assess proficiency in culturally competent care. However, little guidance has emerged to achieve these goals. Clinical training within socioeconomically disparate settings may provide an experiential learning opportunity. We sought to qualitatively explore resident experiences working in the generic clinical learning environments (i.e., exposure to socioeconomically diverse patients across different training sites) and how it shapes cultural competency–related skill development.MethodsResidents were recruited from emergency medicine (EM) programs. We used purposeful sampling across all postgraduate years and elicited experiences related to working at the different sites related to cultural identity, frustrating patient encounters, vulnerable populations, and development of health disparities/social determinants of health knowledge. Individual structured interviews were conducted via phone between May and December 2016. Interviews were audiotaped, transcribed, anonymized, and analyzed using systematic and iterative coding methods.ResultsTwenty‐four interviews revealed three main themes. EM residents’ experiences caring for patients across sites shaped their understanding of: (1) potential patient attributes that affected the clinical encounter, (2) difficulties in building rapport had adverse effect on the clinical evaluation, and (3) residency program and training experiences shaped their clinical preparedness and willingness to work in underserved areas.ConclusionAssessing the impact disparate clinical setting exposures have on trainees’ preparedness to care for socioeconomically diverse patients can provide valuable insight for medical educators into barriers and facilitators to delivering optimal learning and patient care. Participants provided a breadth of stories illuminating their real‐world consciousness and competency with meeting the needs of diverse populations and their access to varied educational outlets to grapple with the disparities they observed. More research is needed to uncover effective strategies to help residents thrive and feel more prepared to care for diverse populations.

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“They're Doing Their Job”: Women’s Acceptance of Emergency Department Contraception Counseling

Cited by 5 publications

References 31 publications

Acceptability of Contraceptive Services in the Emergency Department: A Cross-sectional Survey

Acceptability of Contraceptive Services in the Emergency Department: A Cross-sectional Survey

Factors influencing the conduction of confidential conversations with adolescents in the emergency department: A multicenter, qualitative analysis

Untold stories: Emergency medicine residents’ experiences caring for diverse patient populations

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