Perceptions of Zika Virus, Family Planning Accessibility, and Motivations to Participate in the Z-CAN Program: Qualitative Analysis of Focus Groups with Puerto Rican Women 公开

Abstract

Background: During the 2016-2017 Zika virus outbreak in Puerto Rico, CDC Foundation with technical assistance from the CDC established the Zika Contraception Access Network (Z-CAN) as a short-term emergency response using contraception as a medical countermeasure to prevent unintended pregnancy to reduce Zika-related adverse birth outcomes. Z-CAN provided women in Puerto Rico access to client-centered contraceptive counseling and the full range of reversible contractive methods same-day and at no cost through a network of trained providers.

Objective: The purpose of this study was to explore how Puerto Rican women’s knowledge and beliefs of Zika virus affected their family planning behaviors, perceived accessibility to contraceptive services, and to evaluate motivations for participation in the Z-CAN program.

Methods: A qualitative analysis methodology was used to analyze 24 focus group discussions of women that did and did not participate in the Z-CAN program.

Results: Increasing access to affordable family planning services yielded higher motivation to access contraceptive services. Distance of clinics, complicated processes, and long wait times prevented women from accessing family planning services outside of the context of Zika. Women expressed their satisfaction in easily finding a Z-CAN clinic due to increased number and use of online physician locator. Participants valued the program’s same-day provision of contraceptives without unnecessary medical tests. Participants who received Z-CAN counseling reported their negative impressions of the family planning process shifted towards positive interactions, encouraging further participation. Rate-limiting steps in contraceptive distribution affected provision of all methods at all times; when the supply of full range of methods was not readily available, women were discouraged from accessing the program.

Conclusions: Future emergency response efforts that focus on preventing unintended pregnancy should consider providing the full range of contraceptive methods on the same-day and at no cost. Patient-centered counseling and culturally-appropriate communication materials can build trust in reproductive healthcare and reinforce women’s ability to make autonomous decisions about their reproductive health care. Women’s perceptions of reproductive healthcare can influence participation in contraceptive access programs; the use of formative research is important to understand barriers and facilitators to contraception access, which can be used to inform future contraceptive access programs. 

Table of Contents

I. Background and Context………………………………………………………...… 1

II. Literature Review…...…………………………………………………………….. 5

III. Methods…………………………………………………………………………… 14

IV. Results……………………………………………………………………………... 17

Knowledge, Perception, and Influence of Zika Virus on Family Planning……...... 17

Knowledge and Access of Family Planning Services beyond Context of Zika....... 21

Accessing the Zika Contraceptive Action Network (Z-CAN)……………….……. 25

V. Discussion…………………………………………………………………………. 26

Increasing Access to Affordable Family Planning Services………………………. 27

Importance of Same-day Contraceptive Access…………………………………... 29

Creation of Safety Net to Ensure Reproductive Autonomy……………………….. 31

Trust in Information and Communication Sources……………………………….. 33

Client-Centered Counseling Rebuilding Trust in Healthcare …………………….. 36

VI. Limitations ………………………………………………………………………... 38

VII. Conclusion…………………………………………………………………………. 38

VIII. Sources…………………………………………………………………………….. 39

IX. Figures and Tables…………..…………………………………………………….. 44

Figure 1: Distribution of Focus Group Participants by PRDOH Region…………. 44

Table 1: Knowledge about Zika Virus……..……………………….…………….. 44

Table 2: Reasons for Perceived Risk of Zika Virus Infection and Impact of Zika.. 45

Table 3 Information Source for Family Planning and Contraception Beyond Zika Context….. 45

Table 4: Barriers to Family Planning Information ……………………………….... 46

Table 5: Barriers to Accessing Family Planning Services outside of Zika Context.. 47

Table 6: Reasons to participate or not participate in the Zika Contraception Access Network (Z-CAN) Program…………. 48

Table 7: Information Source about the Zika Contraception Access Network (Z-CAN) Program………………………….. 49 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
关键词	Qualitative Emergency Response Puerto Rico Zika Zika Contraception Access Network Contraception Family Planning Client-centered Counseling Z-CAN
Committee Chair / Thesis Advisor	Eva Lathrop, Emory University
Committee Members	Lisa Romero, CDC
Partnering Agencies	CDC

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