DOI

10.17077/etd.f8knmfco

Document Type

Dissertation

Date of Degree

Spring 2017

Access Restrictions

Access restricted until 07/13/2019

Degree Name

PhD (Doctor of Philosophy)

Degree In

Nursing

First Advisor

M. Kathleen Clark

Second Advisor

Lioness Ayres

First Committee Member

Melissa Lehan Mackin

Second Committee Member

Lisa S Segre

Third Committee Member

Natoshia M Askelson

Abstract

The purpose of the study was to examine reproductive life planning practices among Title X family planning health care providers and clinical staff. Reproductive life planning is a program priority for Title X clinics, those that receive federal money for providing family planning services to low-income women and men. The goal of reproductive life planning is to decrease unwanted and unintended pregnancies and improve preconception health care however; this practice has not been described. First, a conceptual analysis was conducted to create a definition of reproductive life planning that was consistent with the literature. Reproductive life planning is a process that is centered on reproductive and other life goals and is personalized, collaborative, fluid, and focused on health-promotion.

Second, a mixed methods design was used to examine reproductive life planning practices and qualitative interviews were conducted to explore barriers and facilitators to implementing reproductive life planning practices. Data were obtained from health care providers and clinical staff employed at Title X clinics in Illinois, Iowa, Minnesota, Missouri, Nebraska, and North Dakota. A total of 148 clinicians completed a web-based survey which was analyzed to describe which types of patients, the topics covered, and the frequency with which reproductive life planning was discussed during an office visit. Surveys were then examined to identify 20 providers to conduct qualitative interviews with to further explore reproductive life planning practices. The qualitative interviews were also performed to explore the barriers and facilitators clinicians face to practicing reproductive life planning.

The results of the web-based questionnaire were examined mainly with medians and frequencies to examine reproductive life planning practices. Qualitative interviews were coded using a content analysis approach to two aims; one to examine how reproductive life planning was using during clinic visits and two, to identify the barriers and facilitators clinicians face when discussing reproductive life planning with patients.

Findings from the survey and the interviews suggest that most clinicians are discussing pregnancy intentions with their patients. However, from the interviews, three types of scope of reproductive life planning emerged; those clinicians who screened their patients’ pregnancy intentions, those who planted the seed in the patient’s mind, and those who explored the context of a patient’s life and their goals to contextualize how pregnancy and childbearing would fit into their lives in order to clarify pregnancy intention and move toward the corresponding health behaviors. It is argued that the third group of providers is using reproductive life planning as intended by experts. Finally, barriers to RLP discussions were examined as well as approached providers used to overcome the barriers.

In conclusion, many clinicians are practicing reproductive life planning as intended, however many are not. Improved training and protocols are needed to ensure clinicians are providing their patients with the best reproductive life planning discussions. Additionally, systemic structures, like access to quality family planning services, need to be improved to aid clinicians in helping their patient plan their families.

Public Abstract

Almost half of all pregnancies are unplanned; women may not have health preconception health behaviors which may pose risks to the fetus. To help individuals plan their pregnancies, Title X family planning program require health care providers to assess each patient’s reproductive life plan at their visit. I set out to examine how experts define reproductive life planning and then to examine how health care providers use reproductive life planning in their practice and explore the barriers providers face when having this discussion with their patients.

In my dissertation, I define reproductive life planning as a personalized, fluid, and collaborative process that is centered around reproductive and other life goals and health promotion. It includes questions related to pregnancy intention such as do you want children, if so when, and how many. Additionally, these intentions are to be placed in the context of a person’s life goals. I found that most Title X providers are asking their patients about their intentions for children, but many are not discussing their patient’s life circumstances and goals. I also found that providers face many barriers to having this discussion with their patients because often their patients have not thought about their pregnancy intentions nor do they have the means to control their reproduction.

Overall this study indicates that more training needs to be provided to clinicians to talking to patients about their reproductive life plans and there needs to be increased access to family planning services so individuals can achieve their plans.

Keywords

Family planning, Health care providers, Preconception health, Pregnancy intention, Reproductive life plan, Title X

Pages

xii, 179 pages

Bibliography

Includes bibliographical references (pages 170-179).

Copyright

Copyright © 2017 Stephanie Westlake Edmonds

Available for download on Saturday, July 13, 2019

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Nursing Commons

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