Primary care providers' responses to pregnancy intention screening challenges: community-based participatory research at an urban community health centre.

BACKGROUND: Incorporating pregnancy intention screening into primary care to address unmet preconception and contraception needs may improve delivery of family planning services. A notable research gap exists regarding providers' experiences conducting this screening in primary care. OBJECTIVE: To explore primary care providers' perceived challenges in conducting pregnancy intention screening with women of reproductive age and to identify strategies to discuss this in primary care settings. METHODS: This qualitative study emerged from a 2017 community-based participatory research project. We conducted semi-structured, in-depth interviews with 10 primary care providers who care for women of reproductive age at an urban federally qualified health centre. Analysis consisted of interview debriefing, transcript coding and content analysis with the Community Advisory Board. RESULTS: Across departments, respondents acknowledged difficulties conducting pregnancy intention screening and identified strategies for working with patients' individual readiness to discuss pregnancy intention. Strategies included: linking patients' health concerns with sexual and reproductive health, applying a shared decision-making model to all patient-provider interactions, practicing goal setting and motivational interviewing, fostering non-judgmental relationships and introducing pregnancy intention in one visit but following up at later times when more relevant for patients. CONCLUSIONS: Opportunities exist for health centres to address pregnancy intention screening challenges, such as implementing routine screening and waiting room tools to foster provider and patient agency and sharing best practices with providers across departments by facilitating comprehensive training and periodic check-ins. Exploring providers' experiences may assist health centres in improving pregnancy intention screening in the primary care setting.

Adverse childhood experiences and obesity: Systematic review of behavioral interventions for women.

OBJECTIVE: Studies have demonstrated a relationship between adverse childhood experiences (ACEs) and adult obesity. Group interventions addressing the psychosocial sequelae of ACES using a trauma-informed approach for adults are well described in the literature. There is also a significant body of literature on the efficacy and proposed structure of interventions addressing weight reduction in adults. However, it is unknown how often interventions addressing attainment of a healthy weight incorporate a specific focus on adult women with a history of ACEs, including childhood abuse and trauma. METHOD: A systematic review of the literature was conducted using standard approaches. Two additional reviews used broadened inclusion criteria to identify and include group-level interventions that addressed intended outcomes other than obesity. Studies that examined the link between ACEs and obesity as a primary outcome and that provided a description of any potential mediating variables were also identified. The current literature search was conducted as the first step in a multifaceted approach to the development of a set of proposed research protocol designs for an Office on Women's Health-sponsored trauma-informed healthy weight pilot intervention for obese women with a history of ACEs. RESULTS: No articles describing interventions for the treatment of obesity or overweight women with a history of ACEs were identified. Eleven articles describing ACE-related interventions and 15 studies identifying mediators were reviewed. CONCLUSIONS: Intervention studies for women with ACEs, other than psychotherapy, are limited. Significant mediators to be considered include anxiety symptoms and internalizing behaviors. Specific recommendations for interventions are provided. (PsycINFO Database Record