INTRODUCTION: The contraceptive implant is approved by the U.S. Food and Drug Administration (FDA) for 3 years. There is evidence that it is effective at preventing pregnancy for 5 years, known as extended use. We explored clinician perspectives and the barriers and facilitators to offering extended use. METHODS: We utilized the Consolidated Framework for Implementation Research (CFIR) to guide 20 IRB-approved, semistructured qualitative interviews among reproductive health clinicians. Participants were recruited from a nationwide cross-sectional survey on use of the contraceptive implant, with sampling to optimize the geographic and clinical diversity of participants. We coded interviews using ATLAS.ti, and then generated themes by CFIR domain and participant type. RESULTS: We interviewed 20 clinicians: 5 (25%) family medicine physicians, 6 (30%) advanced practice clinicians, 3 (15%) complex family planning (CFP) specialists, and 6 (30%) non-CFP obstetrician–gynecologists. Themes regarding barriers and facilitators to extended use emerged across CFIR domains. Within the outer setting, the dominant barrier was the current FDA approval for 3 years, while the strongest facilitator was educational materials for patients and providers. For the inner setting, the main barrier was clinician concern about liability with off-label use of a contraceptive device and the main facilitator was a champion of extended use. The primary barriers within intervention characteristics were patient concerns about changes in bleeding and future insurance coverage for contraception. CONCLUSION: Clinician education about extended use of the contraceptive implant up to 5 years as well as more data on the expected patient bleeding profile may increase offering of extended use of the contraceptive implant.
INTRODUCTION: Limited data exist regarding the type of support patients need when experiencing early pregnancy loss (EPL). The objective of this study is to explore how patients emotionally cope with EPL and to assess whether there is interest in a peer EPL doula program with a self-compassion component. METHODS: We conducted semistructured interviews with 21 patients who had experienced EPL in the past 2 years. We evaluated the kinds of support that patients felt were most helpful, interest in a possible peer EPL doula intervention, and concerns or suggestions for the creation of such a program. Content analysis was utilized to process the data and identify themes. RESULTS: 52.38% (n=11) of interviewees reported expectant management of their EPL, 23.81% (n=5) reported medication management, and 23.81% (n=5) reported undergoing a dilation-and-curettage procedure. Participants represented various races and ethnicities, income brackets, and insurance statuses. We identified five themes: 1) therapy and in-person support groups are helpful when experiencing EPL, but are sometimes inaccessible; 2) social media support groups are initially advantageous for creating a sense of solidarity, but in the long term can be triggering; 3) support from a peer who has also experienced EPL is valuable; 4) developing self-compassion is important in emotionally coping with EPL; and 5) there is a demand for emotional and informational support after EPL. CONCLUSION: Given the unique types of support participants identified in this study, a peer EPL doula could feasibly provide the emotional and informational support patients desire when experiencing an EPL.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective is to compare the contraceptive failure (pregnancy) rates for various forms of hormonal and intrauterine contraception among young women aged 25 years and younger. A secondary objective is to compare the continuation rates for various forms of hormonal and intrauterine contraception among women of this age.
This article offers the case of cystic fibrosis (CF), a multi-system disease, to illustrate how individuals with chronic illness cultivate and apply embodied knowledge to optimize their well-being. We identified three interrelated processes that occur when disease chronicity and menstrual cyclicity meet: 1) knowledge production with a period-tracking app; 2) application of embodied knowledge to manage life with menstrual-related CF symptoms; 3) cultivation of the body-self as a menstruating woman with CF. These dynamic processes capture how cis-gender women with CF attune to their bodies, navigate their illness, and situate themselves within their lifeworlds. Genetic conditions like CF are apt for studying these processes because adults have managed their disease for decades, with longitudinal experience that often exceeds that of their clinicians. Our evidence elucidates the co-constitutive nature of chronic disease, gendered subjectivity, and biological processes in flux. We explored the menstrual cyclicity of chronic disease symptoms by having 72 participants track their CF symptoms across 4 menstrual cycles on a customized period-tracking app. We performed semi-structured interviews with 20 participants to understand how they interpreted these cyclical CF symptoms. We learned that digital tracking attuned participants to monthly fluctuations in CF symptoms. They applied this knowledge to manage their lives and shape their sense of self. We argue that women with CF produce distinct embodied knowledge during their reproductive years, shaping their illness experience, disease management, overall health, quality of life, and selfhood. The dynamics we describe may reflect broader patterns by which women with other chronic illnesses experience their bodies and understand themselves in the world.
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