Health Disparities
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/30813
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Browsing Health Disparities by Author "Diener, Anelise"
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Item Contraception use, perceived susceptibility to pregnancy, and pregnancy desire among women experiencing homelessness.(2022) Galvin, Annalynn M.; Garg, Ashvita; Griner, Stacey; Diener, Anelise; Akpan, Idara N.; Thompson, ErikaPurpose: Women experiencing homelessness are at higher risk of unintended pregnancy. While contraception may reduce unintended pregnancy rates, women experiencing homelessness have low rates of effective contraception use. In addition to access and affordability, how women perceive their susceptibility to pregnancy on contraception may also explain disparate rates of contraception use. This qualitative study aimed to explore how women experiencing homelessness perceive their susceptibility to pregnancy with and without contraception. Methods: From December 2019 - March 2020, semi-structured interviews (n=19) were conducted among pregnancy-capable (i.e., not sterilized), English-speaking women experiencing homelessness in Fort Worth, TX, 18-45 years of age, as part of a larger system-wide study investigating contraception preferences for women experiencing homelessness. Participants were recruited through flyers at local shelters, active recruitment through case managers, community partnerships, and snowball sampling. Interview questions included hypothetical perceived susceptibility to pregnancy while on and off contraception, pregnancy attitudes, and actual contraception use. Interviews were audio-recorded, transcribed, and analyzed using a seven-step framework method for coding and theme identification. This study was approved by the North Texas Regional Institutional Review Board. Results: Women had a mean age of 33.4 years (SD=7.6 years), with reported race almost evenly split between Black (47%) and White (53%). Primary nighttime residence included emergency shelter (n=7), unsheltered locations (n=6), transitional housing (n=5), and rapid-rehousing (n=1). All but two women reported inconsistent or no contraception use. Most women were confident in general contraceptive efficacy and perceived low pregnancy susceptibility when using hypothetical contraception. Some women found their risk of pregnancy was equal with and without contraception based on perceptions of specific contraception efficacy (e.g., condoms versus pills); fertility and fecundity concerns; and high abstinence self-efficacy. When asked whether they would like to get pregnant in the next year, 47% said no (n=9), 21% said yes (n=4), and 32% said they did not know (n=6). All four participants who wanted to become pregnant in the next year did not report current contraception use at the time of the study. Most women who were unsure or not wanting pregnancy in the next year were also not using consistent contraception. Women who desired pregnancy in the next year or were uncertain of whether they wanted to get pregnant in the next year reported similar perceived susceptibility to pregnancy regardless of contraception use, compared to women not desiring pregnancy in the next year who had a higher perceived susceptibility to pregnancy without contraception and lower perceived susceptibility with contraception. Conclusions: Findings elucidate why some women experiencing homelessness may perceive similar pregnancy susceptibility with both contraception use and non-use. Given the need to have higher susceptibility to pregnancy without contraception use for consistent contraception uptake, findings may better explain lack of actual contraception use, preferences for contraception, and pregnancy desire. Understanding the interplay between perceived susceptibility to pregnancy, housing status, and pregnancy perceptions such as timing-based pregnancy intention can better promote contraception and pregnancy prevention for women experiencing homelessness who do not desire pregnancy.Item Information, Motivation, and Behavioral Skills for Contraception Use among Women Experiencing Homelessness(2022) Garg, Ashvita; Galvin, Annalynn; Diener, Anelise; Griner, Stacey; Akpan, Idara N.; Thompson, ErikaPurpose: Women experiencing homelessness have been reported to have higher rates of sexually transmitted infections, lower rates of contraceptive use, and higher rates of unintended pregnancies than stably housed women. Higher unintended pregnancy and lower contraceptive use in women experiencing homelessness warrant more research on behavioral cognitions for contraception access and utilization in this population. Assessing cognitions that affect contraception behaviors can be guided by utilizing a health behavior theory, such as the Information-Motivation-Behavioral (IMB) Skills model. Therefore, this study explored the IMB characteristics that play an important role in an individual's health behavior and could affect the contraception preferences among women experiencing homelessness. Methods: Semi-structured interviews (n=19) were conducted among women 18-45 years of age, not sterilized, English-speaking, and were currently experiencing homelessness. Women were recruited between December 2019 to March 2020 by convenience sampling through partnerships with local community organizations in Tarrant County. In-person or telephone interviews were conducted. Interviews were audio-recorded, transcribed, coded, and thematically analyzed based on the IMB framework. This study was approved by the North Texas Regional Institutional Review Board. Results: The mean age of women in the study sample was 33.4 years (SD = 7.6) and living situations included emergency shelters (37%), unsheltered locations (32%), transitional housing (26%), and rapid re-housing (5%). In the information construct, most women were aware of different contraceptive methods including intrauterine devices, implants, Depo shots, birth control pills, and condoms; however, many desired to learn more about the side effects of various methods. Additionally, some women had misconceptions regarding the possible side effects of different contraceptive methods. For motivation, most women (n=16) had negative attitudes regarding becoming pregnant at that time. Various reasons for not desiring to become pregnant included age, new responsibilities, presence of other children, finances, health concerns, negative beliefs about abortion, or risks involved with having a baby while being homeless. Additionally, most women had a positive attitude towards their current method of contraception, but their motivation to use a type of contraceptive method depended on side effects and comfort with the method. When examining behavioral skills, benefits and barriers to accessing contraception were inquired. Several women mentioned the better health insurance coverage for birth control would benefit them. Lack of adequate insurance coverage and transportation were the major barriers. Other barriers included financial constraints, not enough knowledge regarding how to use birth control, and not enough information knowing how to get an appointment or start the process of getting birth control. Conclusions: Findings highlight the information, motivation, and behavioral skills for contraception use among women experiencing homelessness. Improving knowledge about side effects of various contraceptive methods, addressing any misconceptions, and increasing accessibility to contraceptive methods by providing transportation and financial assistance while maintaining reproductive autonomy might be effective strategies to improve contraception uptake and reduce unintended pregnancies among women experiencing homelessness.Item Perspectives on Sexual and Reproductive Health Screening Conversations Between Healthcare Providers and Women Experiencing Homelessness(2022) Diener, Anelise; Galvin, Annalynn; Griner, Stacey; Garg, Ashvita; Thompson, ErikaPurpose: Women experiencing homelessness are at a heightened risk of sexually transmitted infections (STI) and unintended pregnancy. While the healthcare setting may be an ideal venue to assess the reproductive health needs of women experiencing homelessness, it is unknown how consistently this may be occurring for a population with competing health and social demands. This study aimed to assess healthcare providers' and women experiencing homelessness' perspectives of reproductive health discussions during healthcare visits. Methods: Semi-structured interviews were conducted with healthcare providers (n=6) and women experiencing homelessness (n=19) between December 2019 and November 2020 in Fort Worth, TX. Interviews were conducted as part of a larger systemwide study examining preferences for, facilitators of, and barriers to contraception for women experiencing homelessness. Participants were recruited through convenience and snowball sampling from local community and healthcare organizations serving the target population. Interviews assessed perceptions regarding need and implementation of women's health exams, birth control counseling, STI testing, and sexual health screening. Coding achieved consensus and thematic analysis was conducted. This study was reviewed and approved by the North Texas Regional Institutional Review Board. Results: Several themes emerged regarding the timing of healthcare appointments, sexual and reproductive health conversations, and perceptions of these conversations among women experiencing homelessness and healthcare providers. Only about half of the healthcare appointments occurred in the last year, within the recommended timeframe for annual health exams. In recalling STI and birth control conversations, women recounted inconsistency in the occurrence of these conversations and screenings. When these conversations occurred, women reflected on both positive (e.g., friendly, comfortable) and negative (e.g., awkward) experiences with their healthcare providers. Finally, healthcare providers described the importance of having sexual and reproductive health conversations. However, healthcare providers acknowledged a bias as they perceive a lack of initiation of these conversations by women experiencing homelessness as disinterest in contraception and sexual healthcare. When aiming to prioritize these conversations, healthcare providers note conflicting priorities, including finding stable shelter, access to food, substance abuse, and healthy relationships with partners among women experiencing homelessness, as additional barriers that hinder the initiation of the conversations. Conclusion: This study identified potential inconsistencies in the frequency and quality of reproductive and sexual health conversations, STI screening, and birth control discussions between healthcare providers and women experiencing homelessness. Assumptions by healthcare providers that interested women will initiate sexual and reproductive health conversations puts the onus on women experiencing homelessness to be knowledgeable about, self-screen for sexually risky behaviors, and advocate for their sexual health needs. These findings, coupled with potentially extended periods of time between healthcare appointments, may highlight an opportunity for enhanced reproductive healthcare for this population. Future interventions can focus on improved sexual and reproductive health screening tools, patient intake forms, and clinical practice guidelines for healthcare providers, which can help achieve sexual and reproductive health equity for vulnerable populations.