Abstract
Study Objective, Design, and Setting
Adolescents face barriers to accessing youth-friendly family planning services, specifically
long-acting reversible contraception (LARC). School-based health centers (SBHCs) can
provide youth-friendly care. A quality improvement project was undertaken to assess
quality of care before, during, and after LARC services at 3 SBHCs, and to identify
specific strategies for improving these LARC services.
Participants, Interventions, and Main Outcome Measures
We interviewed 18 female adolescents who received LARC services. Two independent reviewers
coded deidentified verbatim transcripts; discrepancies were resolved by consensus
with a third reviewer. A guide of themes was structured corresponding to Ambresin's
domains of youth-friendly services. From these domains, we identified emerging themes
using grounded theory, with a focus on practical suggestions for improving LARC services
in SBHCs.
Results
Interviewees ranged in age from 15 to 19 (average: 17) years. Most had insertions
(12 levonorgestrel intrauterine system (LNG-IUS); Mirena®), 1 copper intrauterine device (Paragard®), 5 contraceptive implant (Nexplanon®). Overall, participants were highly satisfied with SBHC LARC services. Within the
domain of communication, 2 key themes emerged: balancing need for information with
concerns about being overwhelmed by information; and interest in information that
directly addresses misconceptions about LARCs. Suggested strategies included providing
postprocedure “care packages” with information and supplies, and supporting a peer-based
network of adolescent LARC users and previous patients to serve as a resource for
new patients.
Conclusion
This quality improvement project, conducted in a unique setting, gave adolescents
a voice. The identified strategies for improving health education, social support,
and outreach might be generalizable to other SBHCs. Future research could explore
the effect of implementing these suggested strategies on reproductive health care
use and outcomes at SBHCs.
Key Words
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Article info
Publication history
Published online: November 18, 2016
Footnotes
The authors indicate no conflicts of interest.
Identification
Copyright
© 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
