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Research Article|Articles in Press, 109960

Elevating the patient voice in contraceptive care quality improvement: A qualitative study of patient preferences for peripastum contraceptive care

  • Annie Minns
    Affiliations
    Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, USA
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  • Christine Dehlendorf
    Affiliations
    San Francisco Department of Family and Community Medicine, University of California, 1001 Potrero Ave., San Francisco CA, USA
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  • Alex F. Peahl
    Affiliations
    Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, USA

    Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA

    Program on Women’s Healthcare Effectiveness Research, University of Michigan, Ann Arbor, MI, USA
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  • Michele Heisler
    Affiliations
    Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA

    Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, USA

    School of Public Health, University of Michigan, Ann Arbor, MI, USA
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  • Author Footnotes
    1 Current location: University of Washington Department of Obstetrics and Gynecology, 1959 NE Pacific St, Box 356460, Seattle, WA, USA.
    Lauren E. Owens
    Footnotes
    1 Current location: University of Washington Department of Obstetrics and Gynecology, 1959 NE Pacific St, Box 356460, Seattle, WA, USA.
    Affiliations
    Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, USA
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  • Barbara van Kainen
    Affiliations
    Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, USA
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  • Kirsten Bonawitz
    Affiliations
    Medical School, University of Michigan, 1301 Catherine St., Ann Arbor, MI, USA
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  • Michelle H. Moniz
    Correspondence
    Corresponding author.
    Affiliations
    Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, USA

    Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA

    Program on Women’s Healthcare Effectiveness Research, University of Michigan, Ann Arbor, MI, USA
    Search for articles by this author
  • Author Footnotes
    1 Current location: University of Washington Department of Obstetrics and Gynecology, 1959 NE Pacific St, Box 356460, Seattle, WA, USA.

      Abstract

      Objective

      Patient-centeredness is an important indicator of peripartum contraceptive care quality. Prior work demonstrates how care fragmentation, provider biases, and other factors sometimes undermine the patient-centeredness and quality of this care. To guide the design of future quality improvement interventions, we explored patient preferences for peripartum contraceptive care.

      Study design

      For this qualitative study, we recruited a convenience sample of individuals receiving prenatal care at the study site and participating in an online survey about their experience of peripartum contraceptive care during February–July 2020. We conducted individual, in-depth, semistructured interviews to assess patients’ preferences for peripartum contraceptive care. Using inductive and deductive qualitative content analysis, we evaluated interview data for patient preferences for peripartum contraceptive counseling and organized preferences into domains to inform future quality measurement.

      Results

      Interviews (lasting 7–26 min) included 21 postpartum individuals, who were largely White with high levels of formal education. Many participants described suboptimal care experiences characterized by insufficient information, inadequate centering of patient values, and, occasionally, disrespectful care. We identified four key themes describing patients’ desire for (1) comprehensive, anticipatory information from one’s peripartum provider; (2) counseling and decision-making that (a) prioritize patient preferences and values and (b) avoid pressure; (3) care that respects patient feelings and wishes; and (4) provider responsiveness to individual patient preferences regarding timing and frequency of counseling.

      Conclusions

      We newly identify four key domains of patient preferences for peripartum contraceptive care. Additional research is needed to understand peripartum contraceptive care preferences among diverse patient populations. Future research should develop validated measures for evaluating the patient experience of peripartum contraceptive care at scale, as part of ongoing efforts to improve the quality and respectfulness of peripartum care.

      Implications

      Patients want peripartum contraceptive care to provide comprehensive, anticipatory information; elicit and respond to their counseling and decision-making preferences; and demonstrate respect for their wishes.

      Keywords

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