Study Objective

This study identified clinician and clinic staff perspectives on facilitators and barriers to providing sexual and reproductive health (SRH) care to depressed young women, a population at increased risk for adverse SRH outcomes.

Design

We conducted in-person semi-structured qualitative interviews, which were audio-recorded, transcribed, and coded by two researchers. We used thematic analysis to identify themes pertaining to care facilitators and barriers within a socio-ecological framework.

Setting

This study was conducted in seven diverse clinics in the U.S. New England region.

Participants

Participants were 28 clinicians and staff (4/clinic), including behavioral health clinicians (n = 9), nurse practitioners (n = 7), nurses (n = 3), medical doctors (n = 3), administrative associates (n = 2), practice managers (n = 2), family planning counselor (n = 1), and medical assistant (n = 1).

Main Outcome Measures

We queried how clinicians and clinic staff identify and manage depression and sexual risk, and what they perceive as facilitators and barriers affecting provision of ideal SRH care to depressed young women.

Results

Themes represented facilitators of and barriers to providing ideal SRH care to high-risk depressed young women at five socio-ecological levels: individual (facilitator: trust in providers; barrier: stigma experiences), interpersonal/provider (facilitator: frequent patient–provider communication; barrier: lack of time during clinic visits to build trust), clinic (facilitator: integration of care; barrier: lack of scheduling flexibility), organization/community (facilitator: training for providers; barrier: funding constraints), and macro/societal (facilitator: supportive policies; barrier: mental health stigma).

Conclusion

Optimizing SRH care to high-risk depressed young women necessitates attention to factors on all socio-ecological levels to remove barriers and bolster existing facilitators of care.

中文翻译：

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医护人员和医护人员对高风险抑郁年轻女性理想的性健康保健的促进因素和障碍的观点：各种临床系统的定性研究。

研究目标

这项研究确定了临床医生和诊所工作人员在为抑郁的年轻女性提供性健康和生殖健康（SRH）护理方面的促进因素和障碍的观点，抑郁的年轻女性具有增加的不良SRH结果风险的人群。

设计

我们进行了面对面的半结构化定性访谈，并由两名研究人员进行了录音，转录和编码。我们使用主题分析来确定与社会生态框架内的护理促进者和障碍有关的主题。

设置

这项研究是在美国新英格兰地区的七家不同诊所进行的。

参加者

参加者有28名临床医生和工作人员（4名/门诊），包括行为健康临床医生（n = 9），执业医师（n = 7），护士（n = 3），医生（n = 3），行政助理（n = 2），执业经理（n = 2），计划生育顾问（n = 1）和医疗助理（n = 1）。

主要观察指标

我们询问临床医生和诊所工作人员如何识别和管理抑郁症和性风险，以及他们认为是为抑郁症的年轻女性提供理想的SRH护理的促进因素和障碍。

结果

主题代表了在五个社会生态层面上为高风险抑郁的年轻女性提供理想的SRH护理的促进者和障碍：个人（促进者：对提供者的信任；障碍：污名化的经历），人际关系/提供者（促进者：患者与提供者之间的频繁交流；障碍：诊所就诊期间缺乏时间来建立信任），诊所（协调员：护理整合；障碍：缺乏安排灵活性），组织/社区（协调员：对提供者的培训；障碍：资金限制）以及宏观/社会（促进者：支持性政策；障碍：心理健康污名）。

结论

优化对高风险抑郁青年妇女的性健康和生殖健康护理需要关注所有社会生态层面的因素，以消除障碍并加强现有的护理促进者。