UMD Theses and Dissertations
Permanent URI for this collectionhttp://hdl.handle.net/1903/3
New submissions to the thesis/dissertation collections are added automatically as they are received from the Graduate School. Currently, the Graduate School deposits all theses and dissertations from a given semester after the official graduation date. This means that there may be up to a 4 month delay in the appearance of a given thesis/dissertation in DRUM.
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Item UNDERSTANDING CHANGES IN CONTRACEPTIVE INTENTION, KNOWLEDGE, AND ATTITUDES IN THE CONTEXT OF THE DELCAN INITIATIVE TO REDUCE UNINTENDED PREGNANCY(2022) Skracic, Izidora; Steinberg, Julia R; Lewin, Amy B; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Unintended pregnancies are consistently linked to a higher risk of negative health, social, and economic outcomes for both mother and child. A Delaware public health initiative sought to expand statewide access to all contraceptive methods, particularly IUDs and implants (also known as long-acting reversible contraception (LARC)), due to their high effectiveness, upfront costs, and provision barriers. This study examined changes in self-reported planned contraceptive use, knowledge, and attitudes prior to and following a visit with a medical provider to better understand the provider role in contraceptive outcomes. A diverse group of women (N=474) were recruited at primary care and women’s health Title-X-funded clinics in Delaware. Pre-visit contraceptive use or plan was assessed with two measures: current method use and a composite of current method use and planned method use. Incorporating women’s contraceptive plans in the pre-visit measure resulted in fewer participants being categorized as switching to LARC (2.3%) after a provider visit, compared to the measure that only accounted for current contraceptive use (8.2%). The strongest predictor of changing to a method of higher effectiveness was pre-visit contraceptive choice. On average, women’s knowledge increased; participants with lower pre-visit knowledge were more likely to improve in knowledge post-visit (p<0.001). On average, positive attitudes about LARC decreased, although some individual items changed in the positive direction while others changed in the negative direction. Those with more versus less positive attitudes before the clinic visit had larger decreases in positive attitudes (p<0.001). The full rollout of the DelCAN initiative was associated with an increase in LARC knowledge, while its association with change in LARC attitudes and effectiveness level of planned method use was mixed. These findings suggest that measuring contraceptive plans as opposed to only current method use before a visit is important when applying a pre-post visit design to evaluations of contraceptive use or plans; broadening the conceptualization and measurement of pre-visit contraceptive use or plans could better capture the sources of change that may manifest in post-visit. Additionally, clinic visits may serve as effective education events, particularly for women with lower contraceptive knowledge, and they may provide a more realistic understanding of different contraceptive methods’ advantages and disadvantages. It is possible that the lack of increase in positive contraceptive attitudes may be attributable to the negativity bias following changes in knowledge and personal experience, but more research is needed to replicate and understand the phenomenon.Item Determinants of Unintended Pregnancy and Modern Family Planning Use(2017) Kim, Theresa Youngjoo; Boudreaux, Michel H; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Unintended pregnancy, defined as a pregnancy that is mistimed or unwanted, is one of the world’s most common negative health outcomes. Furthermore, the United Nations Population Fund has found that 225 million women wish to delay or avoid pregnancy yet do not engage in modern family planning method use. Unintended pregnancy affects both maternal health (by way of nutrient deficiency, reproductive organ deficiency, and mental health) and child health (low birth weight, reduced gestational age, and nursing difficulties). The most life-saving and cost-saving means to prevent unintended pregnancy is to encourage modern family planning use. This dissertation examines family planning and unintended pregnancy in three different national contexts. In these studies, I: 1. Decompose the differences in unintended pregnancy rates for black and Hispanic women compared to white women in the United States; 2. Examine the relationship among indicators of health literacy, health system access, and utilization of modern family planning in Senegal; 3. Evaluate an intervention in Benin designed to increase modern family planning use. My research found that black and Hispanic women had a greater likelihood of unintended pregnancy compared to white women. However, psychosocial and socioeconomic factors contributed to the greater likelihoods of unintended pregnancy among racial and ethnic minorities. Among indicators of health literacy, oral and visual messages were the strongest predictors of health system access and modern family planning use in Senegal. The conclusion of the intervention in Benin found that social diffusion behaviors increased among people in the treatment group, and furthermore, the intervention did reduce unmet need for modern family planning use. These research results, though from different research studies, can imply that increasing access as much as possible to modern family planning use can ultimately prevent unintended pregnancy.