The Role of Value Concordance in Family Planning Care for Underserved Women
Open AccessTailoring family planning care to patients' needs and preferences has been recognized as an effective approach to improving contraceptive and family planning outcomes, but only limited knowledge exists on how health care providers incorporate patient values and preferences into their care delivery models. This dissertation attempts to explore the role of value concordance - the degree to which patient experiences match or correspond with their expressed preferences - in the context of family planning services delivered to medically-underserved women. Through a mixed-methods approach, this study uses grounded theory to understand how underserved women form their preferences for family planning care and identifies the specific preferences that underserved women have for receiving family planning services by conducting focus groups and individual interviews with 53 women of childbearing age. The study also incorporates these qualitative findings with the input from a panel of nine technical experts to achieve consensus on an original family planning value concordance (FPVC) measure. This FPVC instrument is used to pilot test the measure in a sample of 110 underserved women of childbearing age in two community health center (CHC) sites. Standard factor analyses and psychometric tests are performed to assess the reliability and validity of the FPVC measure in the target population.The most significant findings emerging from the grounded theory phase of the study was an original conceptual framework to understand value concordance in the context of family planning services. This framework outlines six factors that influence how women form their preferences: life stage, health beliefs and culture, access to services, patient-provider interactions, information, and social support. These factors were described by patients to strongly influence how they make family planning and reproductive health decisions. In the follow-up survey effort, an FPVC measure of 13-items was finalized through exploratory factor analysis and tested among the pilot sample. The average FPVC score was observed at 0.573 representing approximately 57 percent of patient experiences matching or corresponding to patient preferences. FPVC scores were modestly positively associated with patients' satisfaction with providers (p-value=0.068) and with clinical settings within which they received family planning care (p-value=0.093). It was also positively associated with family planning knowledge (p-value=0.096). No evidence of relationships between FPVC and contraceptive use (p-value=0.634) or contraceptive discontinuation (p-value=0.530) was observed. The FPVC scale exhibited moderate reliability with an overall internal consistency of a=0.696. This study offers a preliminary conceptual framework to apply value concordance to the delivery of family planning care and supports the proposition that improved quality and patient-centeredness can improve family planning decision-making among underserved women. With additional testing, the original FPVC measure serves as a promising early mechanism to assess patient preferences and evaluate the degree to which value concordant care can occur in health center settings. In light of the recent changes in the women's health policy landscape, offering these two tools is a critical step in ensuring that high quality, value concordant family planning care is available to underserved women to help them achieve the family planning and reproductive health goals they desire.
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