Browsing 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 Contraceptive Method Use and Insurance Status among U.S. Women aged 15-49 years(2024-03-21) Brilleslyper, Emma; Akpan, Idara; Diener, Anelise; Thompson, ErikaPurpose: Healthy People 2030 set a goal to reduce unintended pregnancies to 36.5%, from the current baseline of 43%. Different methods of contraception have varying efficacy and effectiveness for pregnancy prevention. Insurance coverage is a key determinant for contraception access. This study aimed to investigate disparities in contraceptive method choice based on insurance status. Methods: This was a cross-sectional study of a nationally representative sample of women aged 15-49, using the 2017-2019 National Survey of Family Growth. Women not desiring pregnancy reported their insurance status and current method of contraception. Insurance status was operationalized as Private Insurance/Medi-Gap, Medicaid/CHIP, Medicare/other Government Insurance Plan, and Single-Service Plan. The outcome variable, current method of contraception, was operationalized into four categories: most effective methods (intrauterine devices (IUD), hormonal implant), moderately effective methods (pills, patch, ring, injectable), least effective methods (condoms, diaphragm, withdrawal, natural family planning, etc.)#_msocom_1, and no method of contraception. The association between insurance status and contraceptive method was assessed using multinomial logistic regression. Results: Among the participants, reported insurance statuses were private insurance/medi-gap (56.38%), Medicaid/CHIP/State sponsored (25.16%), Medicare/Military/Other government insurance (4.77%), and Single Service Plan/Indian Health Service/Uninsured (13.69%). For current contraception method, the women self-reported using most effective methods (27.20%), moderately effective methods (27.98%), least effective methods (30.76%), and no method (14.02%). Women insured through a single service plan, the Indian Health Service, or uninsured had lower odds of using most effective methods than no method of contraception (OR=0.32, 95%CI=0.13, 0.77), and lower odds of using the moderately effective methods (OR=0.21, 95%CI=0.07, 0.58), versus no method of contraception, compared to women with private insurance. Additionally, women with Medicaid/CHIP/state-sponsored health plan have lower odds of using the moderately effective methods (OR = 0.382, 95%CI=0.18, 0.84) versus no method of contraception, compared to women with private insurance. Conclusion: There were differences in contraceptive method choice based on insurance status. As all insurance plans are mandated to cover all FDA-approved methods of contraception, our study findings highlight the need to investigate further gaps in access, education, and freedom of choice. Future research should examine the causes underlying our findings and seek to identify potential strategies related to insurance status to improve access and reduce the risk of unintended 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.Item Sexually Transmitted Infections: Does knowledge impact perceived susceptibility?(2023) Kinard, Ashlyn; Johnson, Kaeli; Lemuz, Tiffany; Terrillion, Ryan; Diener, Anelise; Griner, StaceyIntroduction: Young adults (18-24) have high rates of sexually transmitted infections (STIs), including bacterial infections such as chlamydia and gonorrhea. STI research commonly focuses on disease prevention through reducing the associated risk behaviors, such as condomless sexual activity, but limited research exists on risk perceptions related to STIs. Perceived susceptibility, a Health Belief Model construct, describes perceived risk of acquiring a disease. This study assessed perceived susceptibility to chlamydia and gonorrhea and the relationship with STI knowledge. Methods: An online survey panel was used to recruit sexually active young adults aged 18-24 (n=375). STI knowledge was assessed using the Sexually Transmitted Disease Knowledge Questionnaire, a 27-item validated scale. The participants responded to each statement with either true, false, or don’t know. Correct responses were given one point and the scores were averaged to calculate a knowledge score, with a perfect score being 27. Perceived susceptibility to chlamydia and gonorrhea infection was measured using three categories (strongly disagree/disagree, neutral, agree/strongly agree). Demographics including gender, race, sexual orientation, and education status were collected. Participants also reported on prior gonorrhea and/or chlamydia diagnoses as well as current sex practices and risk behaviors. Descriptive and bivariate analyses were conducted in SPSS. This study was approved by the university’s Institutional Review Board. Results: The average knowledge score among participants was 8.3 (standard deviation=5.4, range 0-22). Most respondents perceived that they were not at risk (strongly disagreed/disagreed) for acquiring chlamydia (54%) or gonorrhea (50%). The average knowledge score did not significantly differ by participants perceived susceptibility to chlamydia (p=.087). However, those who agreed/strongly agreed that they were at risk of contracting gonorrhea had a significantly higher knowledge score (mean of 9.9) than those who were neutral (mean knowledge score of 7.7; p=.016) or strongly disagreed/disagreed (mean knowledge score of 8.0; p=.021). Conclusion: The results from this study indicate a significant relationship between STI knowledge and perceived susceptibility to contracting gonorrhea, leading to the conclusion that individuals with more knowledge about STIs can more accurately assess their potential risk of infection. However, this relationship was not noted with perceived susceptibility of contracting chlamydia. Further exploring the difference in overall STI knowledge scores based on susceptibility of disease may provide insight into specific areas of STI knowledge to improve. Future aims should be broadly directed towards STI education among sexually active young adults to increase perceived susceptibility to these infections and improve preventative behaviors, such as increasing condom use.