A population-based study of US women’s preferred versus usual sources of reproductive health care

Abstract

Objective We characterized U.S. women's preferred and usual sources of reproductive health care. Study Design Data were drawn from the Women's Health Care Experiences and Preferences Study, an internet survey of 1,078 women aged 18-55 randomly sampled from a national probability panel. We described and compared women's preferred and usual sources of care (women's health specialists including ob/gyns and family planning clinics, primary care, other) for Pap/pelvic exam, contraception and STI services using Chi-square, logistic regression, and kappa statistics. Results Among women reporting health service utilization (n=984, 92% overall; 77% Pap/pelvic; 33% contraception; 8% STI), women's health specialists were the most used sources of care for Pap/pelvic (68%), contraception (74%), and STI (75%) services. Women's health specialists were also the most preferred care sources for Pap/pelvic 68%, contraception 49%, and STI 35% services, while the remainder of women preferred primary care/other sources or not to get care. Differences in preferred and usual care sources were noted across sociodemographic groups, including insurance status and income level (p-values<0.05). Preference for women's health specialists was the strongest predictor of women's health specialist utilization for Pap/pelvic (aOR 48.8, 95% CI 25.9, 91.8, p<0.001) and contraceptive (aOR 194.5, CI 42.3, 894.6, p<0.001) services. Agreement between preferred and usual care sources was high for Pap/pelvic (85%, kappa 0.63) and contraception (86%; kappa 0.64) services;, disagreement (range 15%-22%) was associated with insurance, employment, income, race, and religion (p-values<0.05). Conclusion Women's preferences for and use of women's health specialists for reproductive health care has implications for efforts to define the role of ob/gyns and family planning clinics in current health systems.

The Link Between Everyday Discrimination, Healthcare Utilization, and Health Status Among a National Sample of Women

“…The GfK panel and their sampling methods have been described in detail previously. 24 Panelists eligible for inclusion in our study (English-speaking women, ages 18-55) were randomly sampled and recruited to participate via an email invitation (n = 2520). A total of 1078 women consented and completed the survey (response rate of 43%).…”

Women's Preferred Sources for Primary and Mental Health Care: Implications for Reproductive Health Providers

“…Obstetrician/gynecologist practices and family planning clinics often have the capacity for integrated models of care, including multidisciplinary staff who are well-versed in task sharing (CDC, 2016 a ; Kaiser, 2014; Farr et al, 2010; Lee, Casanueva, & Martin, 2005; Hall et al, 2015 b ). However, efforts to address the general and mental health needs of reproductive-aged women in reproductive health contexts have been sparse, and it is not clear whether reproductive health specialists are interested in expanding services.…”

“…We have described our study design and sample in detail elsewhere (Hall et al, 2015 a ). In brief, data were drawn from our cross-sectional, population-based, Women’s Health Care Experiences and Preferences Study, an Internet-based survey of 1,078 U.S. women aged 18–55 years conducted in September 2013.…”

“…We have reported on women’s preferred and usual sources of reproductive health specific services (pap smear/pelvic exam, contraception, sexually transmitted infection testing/treatment, pregnancy) elsewhere (Hall et al, 2015 a ). Women were first asked how often on average they had seen a healthcare provider in the past five years and what type of healthcare facility they had visited most often.…”

“…We examined potential covariates based upon prior work (ours and others) in which meaningful associations between reproductive-aged women’s experiences with health service utilization and a wide range of demographic, social, health, and reproductive factors have been noted (Hall et al, 2015 a ; 2014; 2012). Relevant factors which we explored here include age, race/ethnicity, educational attainment, income level, employment status, marital status, religious affiliation and service attendance, residence, type of health insurance, reproductive history including pregnancy, childbirth, and use of prescription/hormonal contraception (ever and in the last year), and health history including chronic disease and mental health diagnoses.…”