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FY 1983 - 2000 - Service Delivery Improvement Research Grants

Increasing Cost of Family Planning Services

Project to Assess the Impact of Increasing Costs on the Delivery of Family Planning and Reproductive Health Services

Grantee Organization:
Cicatelli Associates, Inc.
505 Eighth Avenue, Suite 2001
New York, NY 10018-6505
Principal Investigator: Susan Gadon
Project Period: 9/01 - 9/02

Project Description: Cicatelli Associates, Inc. (CAI) will conduct a case study approach to explore the impact of increasing costs and other factors on the delivery of family planning and reproductive health services over a 5-10 year period. The project will work with a sample of Title X family planning grantees and provider agencies to conduct an in-depth review and analysis of purchasing records, clinic operations, and other records to extract information required to determine the effect that changing costs have had on the delivery of family planning services. A relative value cost methodology will be utilized for each participant agency to determine the unit cost of service by CPT codes. CAI will develop cost of service reports providing in-depth information on the impact of changing costs, as well as other contributing factors, affecting the delivery of family planning services.

Family Planning Client Behavior

Assessing Family Planning and Reproductive Health Needs and Services in the United States

Grantee Organization:
The Alan Guttmacher Institute 120 Wall Street
New York, NY 10005
Principal Investigator:
Jacqueline E. Darroch, Ph.D.
Project Period: 7/01/99 - 6/30/04

Project Description: The objectives of this project include the following:

  1. to document the nation's need for publicly funded reproductive health and family planning services, service providers' capability and success in meeting those needs with attention to the demographic and socioeconomic characteristics of those in need;
  2. to investigate emerging issues and significant trends in publicly funded reproductive health and family planning service delivery, with special attention to the Title X family planning program;
  3. to monitor federal and state funding and policies that affect reproductive health family planning service delivery, including funding provided under Medicaid and other major sources and through managed care mechanisms; and
  4. to disseminate information and analyses that will enable policy makers, providers and other individuals and organizations to improve the quality and reach of reproductive health and family planning services in the U.S.

Improving Condom Use for STD Prevention by Clinic Patients

Grantee Organization:
Family Health Council of Central PA
1017 Mumma Road
P.O. Box 360
Camp Hill, PA 17001-0360
Principal Investigator:
Laraine Winter, Ph.D.
Project Period: 1/98 - 12/00

Project Description: The aim of this study was to evaluate an intervention to increase condom use among partners of family planning clinic patients. Using a prospective cohort design, the study was conducted in three family planning clinics in Pennsylvania and Maryland. A sample of 2,100 female family planning patients under age 30 received one of three counseling strategies - the skill training condition, a control condition with standardized condom education, and a second control condition in which a list of suggestions is added to the standard condom education. The intervention, which is designed to enhance the subjects' negotiation skills in getting partners to use condoms, consists of a counseling based social skill training exercise which targets social barriers to condom use. Patients are first required to identify obstacles to their condom use, and with the help of a counselor devise plans to overcome each obstacle. At the end of their clinic visit, patients were invited to take as many free condoms from a basket of 50 as they wish and complete a questionnaire which assesses intention to use condoms, attitudes, knowledge, number of condoms taken, and frequency of sexual intercourse. Demographic information and STD infection status were gathered from the clinic's Patient Input and Clinic Report Forms. Twelve months later, at the annual clinic visit, patients answered questions about their condom use since the intervention. Also, patient medical charts were examined for evidence of new STD infections since the intervention.

Norplant, Depo Provera, the Pill - Influences and Outcomes

Grantee Organization:
Family Planning Council of Southeastern Pennsylvania
260 South Broad Street, Suite 1900
Philadelphia, PA 19102-3865
Investigator:
Kay A. Armstrong
Project Period: 10/93 - 9/96

Project Description: This study involved clinicians and clients at five Title X funded family planning clinics in Southeastern Pennsylvania and focuses on the three major methods of hormonal contraception: Norplant, Depo-Provera, and oral Contraceptives. It examined two issues. (1) Clinician influences on clients' contraceptive decision- making with a particular focus on the choice of the three hormonal methods, and (2) behavioral compliance outcomes associated with the use of each of the three methods.

Family Planning in Clinic Discontinuation

Grantee Organization:
Family Planning Council of Southeastern Pennsylvania
260 South Broad Street, Suite 1900
Philadelphia, Pennsylvania 19102-3865
Investigator: Roberta Herceg-Baron, MA
Project Period: 10/83 TO 3/85

Project Description: This project examined the complete clinic histories of over 13,000 women in Pennsylvania and follow-up interviews were conducted with a subsample to obtain answers to the following questions:

  1. What are the rates and patterns of clinic discontinuance among family planning clients?;
  2. To what extent ,are personal, clinic, and community attributes associated with the rate of discontinuance?; and
  3. What are-the reasons for clinic discontinuation and what sources are used subsequently by women still desiring family planning care?

Family Planning Performance: Acceptance and Drop-Out

Grantee Organization:
The Johns Hopkins University
School of Hygiene and Public Health
Department of Population Dynamics
615 North Wolfe Street
Baltimore., Maryland 21205
Principal Investigator:
Dr. Lien P. Chow, M.D.
Project Period: 10/83 to 9/85

Project Description: Two major data sources were utilized to study family planning services in Maryland, with emphasis on the study of clinic acceptors and dropouts. First, computerized data files on all new acceptors in Maryland (except Baltimore) for the past five years were assessed to ascertain if the program was increasing its numbers of those it is designed to serve and to analyze the characteristics of dropouts. Second, follow-up interviews of 1,500 women were conducted to determine subsequent contraceptive behavior and fertility and to obtain additional data not available on medical records.

Choice of Family Planning Services Among Poor Women

Grantee Organization:
University of Florida
Department of Psychology
Gainesville, Florida 32611
Principal Investigator:
Lawrence J. Severy, Ph.D.
Project Period: 10/83 to 9/86

Project Description: This project surveyed 1,000 low-income women in need of family planning services in north central Florida to examine the utility of the expectancy-value model in predicting both choice of provider (private physicians, family planning clinics, or other) and change in providers over an 18-month period. The results can alert providers as to whether there are misperceptions about their service delivery systems which can be addressed.

Family Planning Needs of Underserved Women: Contraception, Patient Education and Reproductive Health

Grantee Organization:
University of Southern California
School of Medicine
Department of Medical Education
KAM Room 200
1975 Zonal Avenue
Los Angeles, California 90033
Principal Investigator:
Robert C. Mendenhall, Ph.D.
Project Period: 9/85 to 6/87

Project Description: The study identified low-income women who, while at the risk of unintended pregnancy, are not receiving clinic or private family planning care; determine what are the barriers to service utilization for them; and assess deficits of clinic providers in their efforts to reach such clients. Approximately 600 low income Los Angeles women from different ethnic groups and poverty levels were surveyed, and those survey data will be linked with information from providers located in the same "district" as the surveyed women.

Rural Family Planning Services: An Interactionist View

Grantee Organization:
Cornell Institute for Social & Economic Research
Cornell University
123 Day Hall
Ithaca, New York 14853
Principal Investigator: Burton Mindick, Ph.D.
Project Period: 1/85 TO 12/86

Project Description: The study identified low-income women who, while at the risk of unintended pregnancy, are not receiving clinic or private family planning care; determine what are the barriers to service utilization for them; and assess deficits of clinic providers in their efforts to reach such clients. Approximately 600 low income Los Angeles women from different ethnic groups and poverty levels were surveyed, and those survey data will be linked with information from providers located in the same "district" as the surveyed women.

Adolescent Family Planning Clients

Adolescents' Motivation to Prevent Pregnancy

Grantee Organization:
Child Trends
4301 Connecticut Avenue, N.W., #100
Washington, DC 20008
Principal Investigator:
Barbara W. Sugland, Sc. D.
Project Period: 6/95 - 5/98

Project Description: The goal of this study was to develop a conceptual framework for explaining the determinants of pregnancy risk-taking behavior among youth. To fulfill this aim, the investigators conducted focus groups among a sample of European-American, African-American and Hispanic-American youth aged 16-19 to determine youth perceptions about the decision-making process concerning pregnancy risk-taking behavior; and held concept mapping groups to provide insights into how youth conceptualize the decision-making process for pregnancy risk-taking behavior.

Tailoring Family Planning Services to the Needs of Teens

Grantee Organization:
Family Health Council of Central PA
1017 Mumma Road
P.O. Box 360
Camp Hill, PA 17001-0360
Principal Investigator:
Laraine Winter, Ph.D.
Project Period: 7/94 - 3/98

roject Description: This study followed approximately 2, 000 teen (under 18) female clients of two inner-city Pennsylvania clinic sites and evaluate an intervention strategy designed to improve clinic outcomes for these young women in the areas of contraceptive use, contraceptive knowledge, continued clinic attendance, and pregnancy prevention. Using an intervention strategy referred to as the New Adolescent Approach, the experimental protocols emphasized extended counseling, addressed clients fears and worries, and provided more clinic supervision. Its ultimate goal was to improve the delivery of services to young women who visit family planning clinics.

Abuse Dimensions of Teen Contraception and STD Prevention

Grantee Organization:
The Center for Health Training
400 Tower Building
1809 Seventh Avenue
Seattle, WA 98101
Principal Investigator:
David N. Fine, Ph.D.
Project Period: 3/92 - 2/95

Project Description: Using a sample of 400 subjects (200 abused and 200 non-abused) drawn from Title X clinics in Region X, this project investigated the prevalence of sexual abuse (non-voluntary sexual experience) among the family planning clinics and examined the relationship between sexual abuse and contraceptive compliance and sexually transmitted disease prevention. Another aim of the project was to determine the most effective approach for obtaining client abuse histories and to develop strategies for improving services to sexually active adolescents who are at-risk for contraceptive non-compliance.

Influencing Adolescent Male Contraceptive Behavior and Attitudes

Grantee Organization:
Children's Hospital National Medical Center
Department of Adolescent Medicine
Washington, DC 20010
Principal Investigator:
Lawrence J. D'Angelo, M.D.
Project Period: 7/1/88 - 6/30/92

Project Description: The purpose of this longitudinal study was to investigate the attitudes and behaviors of adolescent males towards contraception. The specific aim of this project, which involved a sample of 500 sexually-active adolescent males aged 11-21 from Title X clinics, was to provide answers to the following questions:

  1. Can the attitudes and behaviors of sexually active males be changed either through an educational program or the availability of free condoms?
  2. How do the attitudes of non-sexually active adolescent males compare with those of their sexually active peers?
  3. What psychosocial variables affect attitudes and behaviors? (4) Has AIDS influenced contraceptive attitudes and behavior?

Effects of Psychosocial Factors on Teen Contraception

Grantee Organization:
University of Texas
Health Science Center at Dallas
Southwestern Medical School
5323 Harry Hines Blvd.
Dallas, TX 75235
Principal Investigator:
Judith B. Keith, Ph.D.
Project Period: 10/86 TO 9/88

Project Description: The goal of this project was to obtain a more comprehensive understanding of adolescent contraceptive behavior by utilizing a multivariable framework that includes psychosocial and cognitive determinants of contraceptive use. Several kinds of data were collected over a six-month period on 200 unmarried, nulliparous adolescent women attending a clinic serving lower-income Black and Hispanic adolescents. The data were analyzed with regard to differences between contracepting and non-contracepting adolescents and between those behaving consistently and inconsistently in the contraceptive area.

Male Family Planning Clients

Reproductive Health Screening of Male Adolescents

Grantee Organization:
Kaiser Foundation Hospitals
Center for Health Research
4610 S.E. Belmont
Portland, Oregon 97215
Principal Investigator:
Ross Danielson, Ph.D.
Project Period: 10/84 to 9/87

Project Description: This project tested the impact on adolescent males, subsequent sexual and contraceptive activity of providing reproductive health information and counseling in combination with the delivery of routine medical care in a HMO setting. Approximately 1,000 males, who were 15-17 years of age and who scheduled routine HMO appointments, were recruited for the study.

The Male Role in Adolescent Contraception

Grantee Organization:
Children's Hospital National Medical Center
Department of Adolescent Medicine
111 Michigan Avenue, N.W.
Washington, D.C. 20010
Principal Investigator:
Lawrence D'Angelo, M.D.
Project Period: 9/85 to 8/86

Project Description: This study sought to determine factors affecting use or nonuse of contraceptives, particularly condoms, through interviews of 500 males, aged 11-19, attending a general medical clinic in an urban hospital setting.

Other Research: A second grant was awarded to Dr. D'Angelo in June, 1988, to evaluate the impact of an educational strategy on both sexually active and non-sexually active adolescent males, as well as the impact of a free condom distribution arrangement on the former.

Males Use of Public Health Contractive Services

Grantee Organization:
University of Illinois
College of Medicine at Rockford
Department of Community Medicine
1601 Parkview Avenue
Rockford, Illinois 61107
Principal Investigator:
Michael Glasser, Ph.D.
Project Period: 4/87 to 3/88

Project Description: The purpose of this research was to obtain a better understanding of the male experience in using public family planning services, as a basis for designing a program to better serve the needs of male clients. Data were obtained from all men utilizing the family planning services of the Winnebago County Public Health Clinic in Rockford, Illinois, during a six-months period. The project sought answers to basic questions such as "Who are male clinic users, why do they use the clinic, and-how satisfied are they?" Specific comparisons were made between males who visit the health department primarily to receive condoms and males who attend the scheduled family planning visits of their female partners.

Targeting of Family Planning Services

Improving Family Planning and Reproductive Health Services for Individuals with Limited English Proficiency

Grantee Organization:
Center for Health Training
1809 7th Ave., Suite 400
Seattle, WA 98101-1341
Principal Investigator:
David Fine, Ph.D.
Project Period: 9/01/2002 - 8/31/2004

Project Description: The aim of this research project is to increase understanding as to how to effectively meet the specific and unique family planning and reproductive health service needs of individuals with limited English proficiency (LEP). The research will consist of a descriptive and exploratory study of the individual, family, clinic and community factors that affect access to family planning and other health services by individuals with LEP. The objectives will also include developing and testing outreach and communication strategies at selected clinics. The research will be conducted at Title X family planning clinics and community-based organizations that represent urban and rural communities in Washington state, particularly in areas with high concentrations of Hispanics and Asian Pacific Islanders.

Meeting the Needs of Substance Abusers: A Title X Service Delivery Model

Grantee Organization:
Family Planning Council, Inc.
260 South Broad Street, Suite 1000
Philadelphia, PA 19102-5076
Principal Investigator:
Linda Hock-Long, Ph.D.
Project Period: 9/01/2002 - 8/31/2004

Project Description: The goal of this project is to implement and evaluate the delivery of Title X funded reproductive health services to an underserved population of substance abusers who are not currently in treatment. The study will examine the changes required of service providers as they expand from one intervention approach (i.e. substance abuse services) to a more comprehensive package of services that include reproductive health services. The investigators will collaborate with two substance abuse organizations, one which provides services to men and women over 18 years of age, and another which provides health promotion programs for hard-to-reach youth ages of 13 to 25. The objective is to build upon the harm reduction outreach model these two substance abuse programs already have in place and integrate the delivery of reproductive health services. Through street outreach, clients will be recruited at mobile van services that are already provided and at centralized service centers where comprehensive clinical and support services are provided. This research will provide insight into how difficult it is to address multiple problems.

Enhanced Family Planning in an STD Clinic to Improve STD Services

Grantee Organization:
Johns Hopkins University, School of Medicine
720 Rutland Avenue
Baltimore, MD 21305
Principal Investigator:
Emily Erbelding, M.D., M.P.H.
Project Period: 9/01 - 9/03

Project Description: This project will evaluate the impact of enhanced STD outreach worker services on the reproductive health outcomes in a cohort of women receiving STD care and contraceptive care in inner city STD clinics. Outcomes will be compared to those of a control cohort of women who are enrolled for a similar range of contraceptive services but do not receive the outreach intervention. The study will measure rates of unintended pregnancy and new STDs among female STD patients in a system with contraceptive public health outreach compared to standard care.

Women Leaving Prison: Two Models of Family Planning Service Delivery

Grantee Organization:
Rhode Island Hospital
593 Eddy Street
Providence, RI 02903
Principal Investigator:
Jennifer Clarke, M.D.
Project Period: 9/01 - 9/03

Project Description: The researchers will evaluate a current Title X-funded family planning program for incarcerated women in Rhode Island who are soon to be released from prison. Clients will be surveyed to determine factors associated with and barriers to seeking family planning services. The study will compare two modes of delivering family planning services to women being released from prison. The first model will evaluate an innovative program that involves initiating family planning education for incarcerated women and then arranging post release connection to a clinic for family planning services. The second model will examine a model in which education and contraceptive methods are offered to women prior to their release from prison and then arranging a post release connection to a clinic for family planning and reproductive health care. Behavioral and biological outcomes will be assessed when testing both these models.

Improvement in Northern Manhattan to Two Underserved Populations: Males and Recent Immigrants

Grantee Organization:
New York Presbyterian Hospital
60 Haven Avenue, B-3
New York, NY 10032
Co-Principal Investigators:
Roger Vaughan, Ph.D and Lorraine Tiezzi, M.S.
Project Period: 10/01 - 9/03

Project Description: This project will identify and explore the enabling factors for, and barriers to, health care seeking behavior among a recent immigrant Hispanic population and among Hispanic males in New York City. The project will conduct several case-control studies at different health care access points (including reproductive health care) available to recent immigrants and males. Structured interviews will be conducted among a sample of older adolescents, young adults and older adults who have demonstrated health care needs and who accessed health care, and among a control group who did not access health care. Structured interviews will also be conducted with parents, as well as with the health care providers in the school-based clinics and the community-based family planning clinics.

Barriers to Family Planning Services Among Mexican Immigrants in California: Gender, Power and Culture

Grantee Organization:
University of California, San Francisco
Department of Obstetrics, Gynecology and Reproductive Sciences
3333 California Street, #315
San Francisco, CA 94118
Principal Investigator:
Catherine Maternowska, Ph.D., M.P.H.
Project Period: 1/01 - 12/02

Project Description: This project focuses on understanding the complex sociocultural factors that influence reproduction and the use of family planning services in Mexican immigrant communities. The research project has three broad aims:

  1. to uncover factors that influence the use of family planning services among male and female Mexican immigrants in California;
  2. to discern if these factors differ among rural (largely migrant) and urban populations; and
  3. to understand providers' behavior and their perceptions of Mexican immigrants in an effort to determine how services can be made more accessible. A sample of Mexican men and women of childbearing age will be recruited for interviews from two groups - clients in the California Family Planning, Access, Care and Treatment Program (Family PACT) and non-Family PACT clients. Interviews will address respondents' fertility histories, contraceptive knowledge and attitudes, financial, time, and health care resources, access to medical care, as well as social and legal networks. The project will also study family planning provider attitudes regarding the Mexican immigrant population and perceptions of their needs.

Improving Family Planning to Southeast Asian Refugees: A Study of Their Knowledge, Attitudes-and Practices

Grantee Organization:
University of Californian-SF
School of Medicine
126 medical Sciences Bldg.
San Francisco, California 94143
Principal Investigator:
Donald H. Minkler, M.D.
Project Period: 10/83 to 3/85

Project Description: The focus of this study is an assessment of the family planning needs of Indochinese refugees presently in California who are seeking self-sufficiency in the United States. Data from official records and interviews of refugees were used to describe fertility patterns, family planning attitudes, and service utilization. Cross-cultural barriers to utilization of family planning services were analyzed, and a cost-benefit analysis was conducted to identify cost-efficient models for the delivery of family planning services to monolingual, cost-cultural groups.

Child Care Adequacy and Family Planning Practices.- A Study of the Fertility Patterns and Contracepting Behaviors of Low-Income Child Housing and Child Neglecting Mothers

Grantee Organization:
The Baltimore City Department of Social Services
Division of Policy and Resource Development
1510 Guilford Avenue
Baltimore, Maryland 21202
Principal Investigator:
Susan J. Zuravin, Ph.D.
Project Period: 12/83 to 5/85

Project Description: This project examined the relationship of child abuse and neglect and contraceptive use and childbearing patterns. Among the project objectives was the development of recommendations about family planning strategies that could address problem areas identified in this study.

Family Planning Needs of the Child Welfare Population

Grantee Organization:
Humanalysis, Inc.
74 Henry Street
Suite 139
Saratoga Springs, NY 12866
Principal Investigator:
Denise F. Polit, Ph.D.
Project Period: 10/85 to 3/87

Project Description: Information to inform strategies for meeting the family planning needs of female adolescents in the child welfare population were obtained from several sources: 1) a national survey of state policies and practices regarding family planning and sexuality counseling in this population; 2) interviews of 150 girls, aged 13-18, who are child welfare clients in metropolitan areas of Missouri, 3) interviews of the girls' caseworkers and parents/guardians or foster parents.

Organization/Management of Family Planning Services

Reassessing United States Family Planning and Reproductive Needs

Grantee Organization:
The Alan Guttmacher Institute
120 Wall Street
New York, NY 10005
Principal Investigator:
Jacqueline E. Darroch, Ph.D.
Project Period: 5/1/94 - 4/30/99

Project Description: The objective of this project was to provide information intended to help assess the current family planning system by:

  1. analyzing the current status of the nation's public family planning providers, including numbers and locations of service sites, staffing, services offered and fees charged;
  2. estimating the need for publicly-funded family planning services;
  3. documenting the numbers of clinics and clients served according to country, state and region;
  4. describing the characteristics of family planning clients;
  5. documenting the public funds spent on family planning services;
  6. analyzing private physician contraceptive service delivery; and
  7. describing linkages between family planning clinics and STD clinics and school-linked health services. The information is expected to be useful in the development of services and policies aimed at reducing the level of unintended pregnancy, as well as suggesting means to improve other areas of reproductive health.

Integration of Contraceptive Services into an STD Clinic

Grantee Organization:
Johns Hopkins Hospital
Infectious Diseases Division
600 N. Wolfe Street
Baltimore, MD 21205
Principal Investigator:
Edward W. Hook, M.D.
Project Period: 4/1/87 - 3/31/90

Project Description: The primary goal of this study was to investigate the benefits of integrating contraceptive services in inner-city STD clinics. It involved a prospective study of the benefits of offering free on-site contraceptive counseling and services at STD clinics in terms of 1) contraceptive acceptance and continuation rates; 2) detection of STDs among contraceptive acceptors returning for follow-up visits, and 3) the cost-effectiveness of adding contraceptive services in this manner.

An Assessment of Family Planning Service Delivery in South Carolina

Grantee Organization:
South Carolina Department of Health and Environmental Control
2600 Bull Street
Columbia, South Carolina 29201
Principal Investigator:
Harold D. Gabel, M.D.
Project Period: 10/83 to 9/84

Project Description: This project developed indicators of family planning service effectiveness, which were then related to cost, productivity, and characteristics of service delivery organizations. Resulting analysis were used as a basis for developing model interventions in clinic-level delivery organizations to improve efficiency and effectiveness.

A Mathematical Model for Family Planning Clinic Staffing

Grantee Organization:
University of South Carolina
College of Business Administration
Columbia, South Carolina 29208
Principal Investigator:
Lori Sharp Franz, Ph.D.
Project Period: 1/84 to 12/84

Project Description: This project developed a mathematical staff planning and resource allocation model to assist decision-makers in multi-clinic family planning programs or districts. The model, which was tested with actual data from South Carolina Family Planning Districts, may provide planning and allocation methods such as assigning itinerant staff and scheduling individual clinic operations to meet client demand with minimal cost and staff time.

An Integrated Services Model: Family Planning and Pediatrics

Grantee Organization:
University of Texas Southwestern Medical Center at Dallas
Department of Obstetrics and Gynecology
Division of Maternal Health/Family Planning
5323 Harry Hines Blvd.
Dallas, Texas 75235
Principal Investigator:
Stephen F. Heartwell, Dr.Ph
Project Period: 10/84 to 9/86

Project Description: The study examined quality of care, recruitment and retention of patients, appointment keeping, clinic costs and efficiency, repeat pregnancies and other factors as they are affected by combining family planning with post-partum and new infant assessment so that mothers may receive these services at a single clinic appointment.

Effects of the Integration Model on Family Planning Programs

Grantee Organization:
The Center for Health Training
400 Tower Building
1809 7th Avenue
Seattle, Washington 98101
Principal Investigator:
Susan DeLisle, M.P.H.
Project Period: 10/86 to 11/87

Project Description: This project studied how integration of family planning services with other services affects the character of family planning service provision. It described and compared DHHS Regions I and X using the quality-assurance guidelines of Dimensions of Care (clinical appropriateness, continuity, efficiency, comprehensiveness, accessibility, and accountability). Regional data bases, computerized and archival, were utilized.

Role of Private Physician

Private Physician Family Planning Services in the United States

Grantee Organization:
The Alan Guttmacher Institute
111 Fifth Avenue
New York, New York 10003
Principal Investigator:
Margaret Terry Orr, Ph.D.
Project Period: 10/83 to 9/84

Project Description: This project analyzed data previously obtained from a large national sample of private physicians (obstetricians/ gynecologists, general and family practitioners, and general surgeons). The analysis focused on: 1) describing the role of private physicians in providing contraceptive and infertility services to poor women and 2) estimating the cost of family planning services obtained by poor women from private physicians.

Family Planning Services for Economically Disadvantaged Women: Utilization, Cost and Patient Satisfaction

Grantee Organization:
University of Southern California
School of Medicine
Department of Medical Education
KAM Room 200
1975 Zonal Avenue
Los Angeles, California 90033
Principal Investigator:
Robert C. Mendenhall, Ph.D.
Project Period: 10/83 to 3/85

Project Description: The study involved interviewing low-income Los Angeles-area women concerning source of family planning care and satisfaction with such care. Interview responses were augmented with data supplied by identified physicians and clinics, to provide comparative pictures of private and clinic-provided family planning care. The results may enable family planning clinics to initiate improvements to increase clients, acceptability of the services offered.

Natural Family Planning

Factors Affecting the Choice of Natural Family Planning

Grantee Organization:
International Population Center
San Diego State University
San Diego, California 92182-3083
Principal Investigator:
John R. Weeks, Ph.D.
Project Period: 9/87 to 8/88

Project Description: The aim of this study was to identify possible stumbling blocks to wider utilization of NFP, particularly in Title X settings. Specifically, it assessed the extent to which knowledge of and attitudes toward NFP on the part of family planning clinic administrators, clinic service providers, and physicians in private settings affect the availability of NFP services, controlling for program characteristics, client characteristics, and the sociodemographic background of respondents. Questionnaires were sent to 1,000 providers in Los Angeles and San Diego counties; the results were analyzed and then translated into a set of policy recommendations for removing existing barriers.

Infertility Services

Infertility Services in the United States: Need, Accessibility and Utilization

Grantee Organization:
The Alan Guttmacher Institute
111 Fifth Avenue
New York, New York 10003
Principal Investigator:
Jacqueline D. Forrest, Ph.D.
Project Period: 10/84 to 9/85

Project Description: This project utilized several data sets to estimate 1) need for infertility services among poor women and 2) their ability to access such services from various sources, including family planning agencies.

Counseling Services

Computerized Contraceptive Counseling Aid

Grantee Organization:
University of Wisconsin-Madison
425 North Charter
Madison, WI 53706
Principal Investigator:
Betty A. Chewning, Ph.D.
Project Period: 1/1/88 - 6/30/91

Project Description: The objective of this project was to evaluate the potential of a computerized contraceptive counseling aid to improve Title X family planning Services for women under age 20. Specifically, it evaluated: 1) the receptivity of Title X clients and staff to the computerized aid; 2) whether the computer aid could strengthen the contraceptive knowledge, satisfaction, and confidence of clients in using a method; 3) whether the computer can reduce sexual risk-taking by promoting consistent use of the selected contraception; 4) the computer's ability to encourage the male partner's support for the client's choice ; and 5) whether the computer aid can improve contraceptive compliance.

The Effectiveness of Contingency Planning Counseling

Grantee Organization:
Columbia University
Center for Population and Family Health
60 Haven Avenue, B-3
New York, New York 10032
Principal Investigator:
Pearila B. Namerow, Ph.D.
Project Period: 10/84 to 3/87

Project Description: Approximately 1,500 young adult family planning clients were studied in a randomized clinical trial of an innovative counseling approach which involved the use of a written plan to deal with contingencies that may affect birth control use over time. Effects on continued clinic attendance, use of contraception at last coitus, consistency of contraceptive use, and unintended pregnancy are being examined at six and twelve month intervals.

Aid for Contraceptive Decision-Making

Grantee Organization:
University of Wisconsin
Sonderegger Center
School of Pharmacy
425 North Charter
Madison, Wisconsin 53706
Principal Investigator:
Betty A. Chewning, Ph.D.
Project Period: 11/85 to 12/86

Project Description: This project developed and assessed the content and software of a computerized counseling aid to be used in conjunction with and prior to seeing a health provider. The counseling aid was designed to help the female client gather accurate information regarding tradeoffs associated with different contraceptives, clarify her priorities and select a method which best fits her preferences and circumstances.

Other Research: A second grant was awarded to Dr. Chewning in June, 1988, to evaluate the developed computerized counseling aid in clinic settings.

Strategies of Counseling and Follow-up in Family Planning Clinics

Grantee Organization:
Family Planning Council of Southeastern Pennsylvania
260 South Broad Street
Suite 1900
Philadelphia, Pennsylvania 19102-3865
Principal Investigator:
Kay A. Armstrong, M.S.
Project Period: 11/85 to 10/87

Project Description: This project was conducted to determine which of three counseling approaches -- directive, anticipatory and information (with and without a follow-up component) -- is most effective in promoting clinic continuity and contraceptive compliance. Data were obtained from approximately 3,500 clients of six comparable family planning clinics in Southeastern Pennsylvania at the initial visit and nine months later.

Cross-National Studies

An International Comparison of Unintended Pregnancy, Contraceptive Practice and Family Planning Services

Grantee Organization:
The Alan Guttmacher Institute
111 Fifth Avenue
New York, New York 10003
Principal Investigator:
Jacqueline D. Forrest, Ph.D.
Project Period: 10/85 to 9/87

Project Description: Project Description: This study searched the experiences of other countries to learn how family planning can be delivered in the U.S. more efficiently and effectively. Existing quantitative and qualitative data on 22 developed countries were assembled to provide an overview and frame of reference for in-depth study of four countries -- the U.S., the U.K. (England and Wales), Canada, and the Netherlands.

Family Planning Services Delivery: Danish Experience

Grantee Organization:
Transnational Family Research Institute
8307 Whitman Drive
Bethesda, Maryland 20817
Principal Investigator: Henry P. David, Ph.D.
Project Period: 11/85 to 10/87

Project Description: Population subgroups, whose family planning needs are underserved in the U.S., but better met in Danmark, were the focus of this study, with an emphasis on identifying successful service delivery features that are transferable from Denmark to the U.S. Focused group discussions with Danish users, providers, and policymakers were conducted.