Self-managed Contraceptive Care: Using Human-Centered Design to Enhance Contraceptive Services for Young Women at the Grady Health System Teen Services Clinic Open Access

Regina, Rachel (Spring 2021)

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Background. Young women in the United States face multiple barriers to accessing effective contraception in clinical settings. The COVID-19 pandemic has exacerbated these barriers, but it has also rapidly advanced innovation in health care and opened the door for novel approaches, like self-care. The Grady Health System Teen Services Clinic in Atlanta, Georgia provides youth-centered contraceptive services for low-income and uninsured young women. The COVID-19 pandemic changed the way the Teen Services Clinic delivers contraceptive care. While some changes may be temporary, new services that give young women more autonomy, such as telehealth and home delivery of prescription contraceptives, may have enduring value. This thesis project aims to identify opportunities for self-managed contraceptive care that can enhance sexual and reproductive health services at the Teen Services Clinic and increase patient autonomy.

Methods. Qualitative research and data analysis were used in combination with human-centered design methods. Results from interviews with clinic staff and young women were used to develop an initial set of design concepts. Participants were then engaged in collaborative design sessions to expand on the design concepts and prioritize ideas for further development.

Results. Results from qualitative research highlighted the need for emotional and practical support throughout the contraceptive care journey. Design concepts for emotional support explore opportunities to build individual confidence and cultivate supportive relationships at home and among the clinic community. Concepts for practical support explore opportunities to promote learning and clarify individual responsibilities during clinic visits, as well as extending reproductive health services and education beyond the clinic setting. Concepts and ideas prioritized by both clinic staff and young women offer reliable information on demand that reflects young women’s voices and values, delivered in a format that is easy to access and share.

Recommendations. This thesis project addresses an important first step in developing contraceptive self-care interventions. However, more work is needed to further develop prioritized concepts. It is recommended that clinic staff and young women continue to be engaged as collaborators to explore content, delivery models, and opportunities to integrate with the MyChart patient portal app.

Table of Contents

1.    Introduction 1

1.1. Background 1

1.2. Problem 4

1.3. Purpose and Objectives 5

1.4. Significance 6

1.5. Definition of Terms 6

2.    Literature Review 7

2.1. Teen Pregnancy 7

2.2. Contraception: Barriers to Access and Use 10

2.3. COVID-19 Pandemic: Impact on Contraceptive Care 11

2.4. Self-care Interventions for Sexual and Reproductive Health 14

2.5. Human-centered Design and Health 17

3.    Methodology 22

3.1. Population 22

3.2. Procedures 23

3.3. Instruments 26

3.4. Data Analysis 28

3.5. Ethical Considerations 29

3.6. Limitations 30

4.    Results 30

4.1. Challenges, Themes, and Opportunities Across the Patient Journey 30

4.2. Design Concepts 47

5.    Discussion 59

6.    Recommendations and Next Steps 63

6.1. Additional Ideation Activities 63

6.2. Implementation 64

7.    Reflections on Methods 65

References 69

Appendix 81

About this Master's Thesis

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