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Needs assessment for the development of an intervention to promote LARC provision in primary care

Elizabeth Janiak, Harvard School of Public Health, 2013

Project abstract

Unintended pregnancy is endemic in the United States. Long-acting reversible contraception (LARC) has the potential to dramatically reduce high rates of unintended pregnancy, but these methods remain underutilized. Prior research has demonstrated that a large proportion of women choose LARC when access, knowledge, and cost barriers are removed. In the context of national health care reform, cost barriers to LARC are being ameliorated at the population level. Reducing practiced-based barriers to LARC remains an urgent public health challenge.

Generalist primary care providers are optimally positioned to reach women at risk of unintended pregnancy due to their high level of contact with this population. Therefore, the provision of LARC in primary care constitutes a highly promising strategy to reduce unintended pregnancy. However, determinants of LARC provision in primary care settings have not been systematically explored.

Our study will address this gap in the literature. Through this mixed-methods, formative research study, we will: 1) enumerate facilitators of and barriers to LARC provision in a primary care setting; and, 2) design a pilot intervention to increase LARC provision in primary care. We hypothesize that a multifaceted intervention will be required to successfully affect LARC provision in primary care.

We will use the results of this study to design an intervention with components targeting both provider attitudes and knowledge, and health center infrastructure. Following completion of this formative research study, we then plan to pilot and evaluate the impact of the resulting intervention as the next phase of this project.

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