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January 14, 2008

Natural Family Planning Use Among Hispanic and African American Young Adult Women: Qualitative and Quantitative Approaches. January 14, 2008. Jennifer Manlove, PhD Lina Guzman, PhD. Background. Overall NFP use is low: 1-4% of all women use NFP each year Higher ever use of NFP:

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January 14, 2008

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  1. Natural Family Planning Use Among Hispanic and African American Young Adult Women: Qualitative and Quantitative Approaches January 14, 2008 Jennifer Manlove, PhD Lina Guzman, PhD

  2. Background • Overall NFP use is low: • 1-4% of all women use NFP each year • Higher ever use of NFP: • 12% of young adult women (18-29) • Higher use among minorities • Especially Hispanics and African Americans • Failure rates: • 3-5% with consistent and correct use • 25% with typical use (user failure)

  3. Gaps in Research • Little is known about the who, why and when of NFP use in the US • Current measures may underestimate NFP use • Little research has examined factors associated with NFP use • Information about NFP users’ knowledge, attitudes and perceived benefits of NFP use is also limited • Incomplete understanding of the effectiveness of NFP use for preventing unintended pregnancy

  4. Key Questions and Potential Problems • Preliminary findings from Hispanic unmarried parents suggests that many women equate “birth control” with hormonal methods and underreport NFP use: I: What about the withdrawal method? Did that come to mind when you were thinking about birth control in this question? R: No, I was thinking about something like, specific, like medicines or something. I: And why would you say that those two methods [rhythm method and withdrawal] you don’t really consider as much as the others? R: Cause we’re not really doing anything really to prevent, the fertilization of an egg.  I mean when I think of birth control, I think of like something, a product.  I: So when you heard the phrase birth control, what kind of methods did you think of? R: Um, the first one I thought of was the depo-provera shot.  When I think of birth control I think of something permanent.

  5. Key contributions • We build on previous research by: • Identifying multiple domains of influence on NFP (family, individual, partner/couple and community) • Examining knowledge, attitudes and perceptions about NFP among young adult women and family planning staff • Assessing the effectiveness of NFP use compared with no method and with other methods

  6. Conceptual framework: Behavioral model of health service use P redisposing Enabling Perceived Need Characteristics Resources for Services Demographics Family/Individual P erceived/ Evaluated Need Age Insurance R ace/ethnicity Poverty status Sexual activity Immigrant Funding for services Perceptions of Relationship status & prescriptions p regnancy, STD risk Previous children Partner risk - taking Condom use Use of Social Structure Community Resources Hormonal method use natural family Family structure Presence of accessible/ planning Parent education affordable family Individual education planning services Culturally appropriate program staff Attitudes/Beliefs/Knowledge Awareness of programs Cultural /religious beliefs Knowledge re: family p lanning Perceived barriers/facilitators to NFP, hormonal methods Family, peer, & partner belief s

  7. Study’s Three Stages • Stage 1: 3 waves of one-on-one semi-structured cognitive interviews • Stage 2: Focus groups with program staff and service providers • Stage 3: Quantitative analysis

  8. Qualitative Components:Stages 1 & 2

  9. Stage 1: Key Research Questions • What are the factors associated with the use of NFP? • How is knowledge about and perceptions of NFP associated with use? • What are predictors of successful NFP use and factors associated with discontinuation in use?

  10. Stage 1: Qualitative Interviews Study Design Baseline Interviews • Collect data on predisposing characteristics, enabling resources and perceived need 6-Month Follow-Up Interviews • Focus on short-term changes in contraception methods, relationship and pregnancy status and sexual activity. 12-Month Interviews • Focus on predictors of contraceptive success, (the avoidance of an unplanned pregnancy)

  11. Stage 1: Sample Design • Target sample: • Hispanic and African-American women using Title X funded clinics in DC • EVER used NFP • Ages 18-29

  12. Stage 1: Recruitment & Screening • Recruitment: • Building from current local contacts • Work with 2-3 local clinics • Anticipate recruitment will take at least 6 months • Key to success will be establishing strong partnerships and buy in from program at all levels • Offering stipend to clinics; • Communicate potential benefits of study to clinics • Screening • High levels of screening to identify target population • Brief interview, easily administered by staff or research staff • Questions designed to identify the methods women are currently using and those that have ever used NFP • Questions will seek to ensure that: • Target population is identified • Underreporting of NFP is minimized

  13. Stage 1: Benefits of Qualitative Interviews • Sensitive and highly personal topics can best be explored in a one-on-one interview • Semi-structured interviews: • Allow a thorough exploration of the respondent’s thoughts, feelings, attitudes and behaviors • Ensure that key topics and issues are addressed similarly for all participants • Provide greater flexibility than a structured interview to pursue topics unique to the individual’s situation • Cognitive probes helpful in identifying target group and better understanding complex topics (e.g. why and when)

  14. Stage 2: Focus Groups Study Design Research Question: How are reproductive health decisions influenced by enabling resources, in particular programs and services? Target Population: Providers (e.g., program directors, nurses, doctors) from programs and clinics in Washington, DC

  15. Stage 2: Focus Groups • Sample: • 3-4 focus groups • 8 to 10 participants per group (total 24-40) • Group segmented by roles & responsibilities • doctors and nurses • program staff who meet directly with clients about reproductive health • program and clinic directors • Content: • Providers’ perceptions of NFP • How prevalent is it use among its clients? • Should NFP be offered as an option? • Dissemination of information • How often is information about NFP requested? • Do they offer this information? Why or why not? • Do they think it should be offered?

  16. Stage 2: Benefits of Focus Groups • Useful for providing insights based on group interactions and assessing the extent to which there is consensus on an issue • Focus groups are more appropriate settings for identifying barriers and facilitators to NFP use from a program/service perspective • Help identify and receive feedback on recommendations for improving access to NFP information

  17. Quantitative Analysis:Stage 3

  18. Stage 3: Quantitative Analysis Research Questions • How are predisposing, enabling, and perceived need factors are associated with NFP use among young adult women? • Do predictors of NFP use differ by race/ethnicity? • How is NFP use among young adult women associated with unintended childbearing?

  19. Stage 3: Quantitative Analysis Data • NSFG (2002 and forthcoming 2006-2008) • Cross-sectional • Over-samples Hispanics and African Americans • Measures of immigration, language status • Family planning providers • National Longitudinal Study of Adolescent Health (Add Health) (Wave III and upcoming Wave IV) • Large, longitudinal sample (15,000+) • Large Hispanic sample • Measures unintended pregnancy

  20. Stage 3: Dependent Variables • NFP use • Ever used NFP (NSFG) • Used NFP in the past year (NSFG, Add Health) • Contraceptive method (NSFG, Add Health) • Unintended birth • Unwanted birth or mistimed birth (Add Health)

  21. Stage 3: Descriptive Information (NSFG)

  22. Stage 3: Descriptive Information (NSFG)

  23. Stage 3: Predictors of NFP use • Predisposing factors • Socio-demographics (age, race/ethnicity, immigration) • Family structure / marital/union status • Reproductive health knowledge • Enabling resources • Insurance coverage, poverty level • Publicly-supported family planning provider in county • Perceived need for services • Sexual experience and activity • Characteristics of sexual partners and relationships • Attitudes about pregnancy, perceived STD risk • Other contraceptive methods

  24. Stage 3: Analysis • Bivariate and multivariate analyses • Logistic regression (NFP use vs. no use; unintended birth vs. no birth/intended birth) • Multinomial logistic regression (NFP use vs. other method use vs. no use) • Interactions by race/ethnicity and immigrant status

  25. Conclusion • Three stages will inform each other and provide a better understanding of the use of NFP among young adult women

  26. www.childtrends.org www.childtrendsdatabank.org

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