Amber L Hill1, Hadas Zachor2, Kelley A Jones1, Janine Talis1, Sarah Zelazny3, Elizabeth Miller1. 1. 1 Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 2. 2 Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois. 3. 3 Allegheny Health Network Trauma Centers, Allegheny Health Network, Pittsburgh, Pennsylvania.
Abstract
Background: Family planning (FP) providers are in an optimal position to address harmful partner behaviors, yet face several barriers. We assessed the effectiveness of an interactive app to facilitate implementation of patient-provider discussions about intimate partner violence (IPV), reproductive coercion (RC), a wallet-sized educational card, and sexually transmitted infections (STIs). Materials and Methods: We randomized participants (English-speaking females, ages 16-29 years) from four FP clinics to two arms: Trauma-Informed Personalized Scripts (TIPS)-Plus and TIPS-Basic. We developed an app that prompted (1) tailored provider scripts (TIPS-Plus and TIPS-Basic) and (2) psychoeducational messages for patients (TIPS-Plus only). Patients completed pre- and postvisit surveys. We compared mean summary scores of IPV, RC, card, and STI discussions between TIPS-Plus and TIPS-Basic using Wilcoxon rank-sum tests, explored predictors with ordinal regression, and compared implementation with historical data using chi-square. Results: Of the 240 participants, 47.5% reported lifetime IPV, 12.5% recent IPV, and 7.1% recent RC. No statistically significant differences emerged from summary scores between arms for any outcomes. Several significant predictors were associated with higher scores for patient-provider discussions, including race, reason for visit, contraceptive method, and condom nonuse. Implementation of IPV, RC, and STI discussions increased significantly (p < 0.0001) when compared with historical clinical data for both TIPS-Basic and TIPS-Plus. Conclusions: We did not find an added benefit of patient activation messages in increasing frequency of sensitive discussions. Several patient characteristics appear to influence providers' likelihood of conversations about harmful partner behaviors. Compared with prior data, this pilot study suggests potential benefits of using provider scripts to guide discussions.
RCT Entities:
Background: Family planning (FP) providers are in an optimal position to address harmful partner behaviors, yet face several barriers. We assessed the effectiveness of an interactive app to facilitate implementation of patient-provider discussions about intimate partner violence (IPV), reproductive coercion (RC), a wallet-sized educational card, and sexually transmitted infections (STIs). Materials and Methods: We randomized participants (English-speaking females, ages 16-29 years) from four FP clinics to two arms: Trauma-Informed Personalized Scripts (TIPS)-Plus and TIPS-Basic. We developed an app that prompted (1) tailored provider scripts (TIPS-Plus and TIPS-Basic) and (2) psychoeducational messages for patients (TIPS-Plus only). Patients completed pre- and postvisit surveys. We compared mean summary scores of IPV, RC, card, and STI discussions between TIPS-Plus and TIPS-Basic using Wilcoxon rank-sum tests, explored predictors with ordinal regression, and compared implementation with historical data using chi-square. Results: Of the 240 participants, 47.5% reported lifetime IPV, 12.5% recent IPV, and 7.1% recent RC. No statistically significant differences emerged from summary scores between arms for any outcomes. Several significant predictors were associated with higher scores for patient-provider discussions, including race, reason for visit, contraceptive method, and condom nonuse. Implementation of IPV, RC, and STI discussions increased significantly (p < 0.0001) when compared with historical clinical data for both TIPS-Basic and TIPS-Plus. Conclusions: We did not find an added benefit of patient activation messages in increasing frequency of sensitive discussions. Several patient characteristics appear to influence providers' likelihood of conversations about harmful partner behaviors. Compared with prior data, this pilot study suggests potential benefits of using provider scripts to guide discussions.
Entities:
Keywords:
IPV; family planning; implementation; primary care; reproductive coercion
Authors: Judy C Chang; Michele Decker; Kathryn E Moracco; Sandra L Martin; Ruth Petersen; Pamela Y Frasier Journal: J Am Med Womens Assoc (1972) Date: 2003
Authors: Amber L Hill; Elizabeth Miller; Sonya Borrero; Sarah Zelazny; Summer Miller-Walfish; Janine Talis; Galen E Switzer; Kaleab Z Abebe; Judy C Chang Journal: J Womens Health (Larchmt) Date: 2021-01-18 Impact factor: 3.017
Authors: Amber L Hill; Hadas Zachor; Elizabeth Miller; Janine Talis; Sarah Zelazny; Kelley A Jones Journal: J Womens Health (Larchmt) Date: 2020-11-18 Impact factor: 2.681