INTRODUCTION
Hello. My name is (insert name). I am representing Total Solutions, Inc., an independent organization that is working to gather information about the Zika Contraception Access Network (Z- CAN).
Welcome and thank you for agreeing to participate in this interview. Your experience and opinions are very important to us. Your participation in this interview will help us understand your experience as a physician within the Zika Contraception Access Network (Z-CAN).
We are especially interested in learning about your perceptions regarding:
barriers to providing contraceptive services,
the implementation of the Z-CAN program,
the reimbursement process for Z-CAN services provided, and
how to continue to improve access to contraceptives for women in Puerto Rico.
As part of our protocol, all interviews are recorded. However, everything you say will be kept private, and your name and the names of others will not be used in reporting the findings of the study. The tape will be stored safely in a locked facility until it is transcribed, after which it will be destroyed. Your name and the name of your clinic will not be transcribed. The interview will take no more than an hour and is completely voluntary. You can choose to stop or skip any questions that you don’t want to answer. We realize you are very busy and we appreciate your time.
Before we begin, do you have any questions for me?
Introductory questions
MODERATOR: First, I would like to ask you about your experience providing contraceptive services to women of reproductive age in Puerto Rico.
How long have you been providing contraceptive services in Puerto Rico?
How would you describe your practice?
Probe: Private practice/community health center, large/small, rural/urban?
How would you describe the women of reproductive age that you serve in your practice?
Probe: Demographics? Type of services they seek? Insurance status?
Contraceptive Counseling
MODERATOR: Now I would like to ask you a few questions about contraceptive counseling. Please take a few minutes to think about your experience counseling women about contraception and how these services are delivered in your practice to women of reproductive age during the Z-CAN program.
What does patient-centered contraceptive counseling mean to you?
Probe:
What are some of the key features of patient-centered contraceptive counseling?
What are your thoughts on performing patient-centered contraceptive counseling in your practice?
Probe:
Who provides the majority of counseling about contraceptives? You or your clinic staff? Why?
What are the challenges with performing patient-centered contraceptive counseling in your practice?
Probes:
Do you have enough time in your schedule?
Has your clinic staff been supportive of providing patient-centered contraceptive counseling?
Has the Z-CAN program training changed how you provide contraceptive counseling to women in your practice?
Probes:
Why or why not?
How is it different?
Will you continue to provide patient-centered contraceptive counseling after or outside the Z-CAN program?
Probe: Why or why not?
Perceptions of barriers to contraception access among women of reproductive age
MODERATOR: Thank you. Now, I would like to ask you a few questions about access to contraceptive methods for your patients. We would like to know about factors that you perceive act as a barrier to contraceptive method access for women of reproductive age.
Why do women in Puerto Rico not seek out or utilize contraceptive services?
Probes:
Awareness/knowledge about contraception?
Beliefs/attitudes towards contraception?
Cultural issues? Religious issues?
Support/lack of support of partner/spouse, family, healthcare providers, friends?
Thinking back to before the Z-CAN program, what challenges did women of reproductive age encounter when seeking contraception?
Probes:
Access to appointments?
Access to patient-centered contraceptive counseling?
Access to long-acting reversible contraception, such as IUDs and implants?
Insurance coverage/cost of different types of birth control?
With the Z-CAN program, what are some challenges to contraception access that women of reproductive age in Puerto Rico still experience? Are there any new challenges?
Probes:
Access to appointments?
Access to patient-centered contraceptive counseling?
Access to long-acting reversible contraception, such as IUDs and implants?
Insurance coverage/cost of methods?
Thinking back to before the Z-CAN program, what challenges did you face in providing contraception, especially LARC methods?
Probes:
Training? For whom?
Contraceptive method procurement?
Reimbursement?
Low demand among patients?
Community issues? Culture? Beliefs?
With the Z-CAN program, what are some challenges you still experience in providing contraception, especially LARC methods?
Probes:
Training? For whom?
Contraceptive method procurement?
Reimbursement?
Low demand among patients?
Time to offer guidance with patients?
Clinic flow (i.e., volume of patients at the clinic)?
Community issues? Culture? Beliefs?
Knowledge, attitudes, and practices related to reversible contraception
MODERATOR: Now, I am going to ask you some questions about reversible contraception methods.
How would you describe the availability of long-acting reversible contraception methods, such as IUDs and implants, in Puerto Rico overall before the Z-CAN program?
Probes:
Were you able to provide IUDs to women in your clinic before Z-CAN?
Were you able to provide implants to women in your clinic before Z-CAN?
How would you describe the availability of long-acting reversible contraception methods, such as IUDs and implants, in your clinic before the Z-CAN program?
Probes:
Were you able to provide IUDs to women in your clinic before Z-CAN?
Were you able to provide implants to women in your clinic before Z-CAN?
How would you describe the availability of other reversible methods in Puerto Rico overall before the Z-CAN program?
Probes: pills? patch? ring? injection? condoms?
How would you describe the availability of other reversible methods in your clinic before the Z-CAN program?
Probes: pills? patch? ring? injection? condoms?
What new information have you learned about providing IUDs and implants to women of reproductive age from the Z-CAN program?
Probe:
What additional information do you wish the Z-CAN program had provided?
What additional training do you wish the Z-CAN program had provided?
How comfortable are you with inserting IUDs? Removing IUDs?
How comfortable are you with inserting implants? Removing implants?
In what situations is a woman not a good candidate for an IUD or implant?
Probe:
Can you think of any more situations?
Do you have concerns about women being pressured to choose certain types of contraceptive methods, such as IUDs and implants?
Probe: By whom? Why or why not?
Implementation of Z-CAN program
MODERATOR: Thank you for your thoughts. Now, I would like to ask you a few questions about the Z-CAN program. We would like to learn more about your experience as a physician in the Z-CAN program.
What aspects of the Z-CAN program do you think have had the most influence on your ability to provide quality patient-centered contraceptive counseling?
Probe: What parts? How so? In what ways?
How would you describe the impact, if any, Z-CAN has had on addressing barriers to access to reversible contraception for women seeking services at your clinic?
Probes:
What barriers in access have been addressed by Z-CAN in your clinic?
What barriers in access remain?
How would you describe the impact, if any, the Z-CAN program has had on contraceptive access and use among women seeking services at your clinic?
How would you describe the impact of access to contraceptive services for the women in your community?
Describe some of the challenges that you have encountered during the implementation of the Z-CAN program.
Probe:
Changes to clinic flow, staffing, Z-CAN procedures, time it takes to counsel patients and answer questions, etc.
What strategies have you used to overcome these issues?
How would you describe your satisfaction with how the Z-CAN program has been implemented in Puerto Rico?
Probe: What can be improved?
How would you describe your satisfaction with how the Z-CAN program has been implemented in your clinic?
Probe: What can be improved?
What are some concerns that you have regarding the provision of contraceptive services in your clinic?
Probes:
What are some concerns you may have about long-acting reversible contraceptive methods (LARCs)?
Are you concerned that you are providing too many contraceptive services to the exclusion of other services you may provide at your clinic?
What do you think are the long-term implications of being a Z-CAN provider? Positive or negative implications? Solutions?
To what extent are you satisfied with Z-CAN training you received?
Probe: What can be improved?
To what extent are you satisfied with responsiveness of the Z-CAN program staff?
Probe: What can be improved?
Reimbursement and Supply Processes
MODERATOR: Now I would like to ask you some questions about how the Zika virus has impacted your practice.
What are your perceptions about costs associated with inserting and removing IUDs and implants?
Probes: Costs to you? Costs to the patient? Costs to the healthcare system?
What do you think about the Z-CAN reimbursement process? How well is it working for you? (SKIP for CHC Providers)
Probes: What makes the reimbursement process easy or difficult? Why or why not?
What was the time interval like between service delivery and receipt of reimbursement? (SKIP for CHC Providers)
Probe: How long did it usually take to receive reimbursement for service delivery?
Has the Z-CAN program provided you with all contraceptive methods on a continual basis?
Probes:
Do you run out of product?
What products do you run out of?
Do you feel like the re-ordering and resupply process is working well?
Zika Virus
MODERATOR: Now, I would like to ask you a few questions about how the Zika virus has impacted your practice.
In your practice, how often do women express concerns about Zika when seeking contraception services?
What advice are you providing women to protect themselves from Zika infection?
Probe:
Is there any other information that women can receive on Zika in your clinic?
Program Recommendations and Sustainability
MODERATOR: We have come to the last series of questions of the interview. Thank you for everything you have shared thus far. I would like to ask you some questions about how expanded access to contraceptives in Puerto Rico can be sustained.
What are your plans to continue providing patient-centered contraceptive counseling for women of reproductive age after the Z-CAN program ends? (around March 2018
Probe: What is needed to ensure the sustainability of these efforts?
What are your plans to continue providing same-day access to the full range of reversible contraceptive methods for women of reproductive age after the Z-CAN program ends?
Probes:
What is needed to ensure the sustainability of these efforts?
Will efforts need to be different for IUDs and implants than for other reversible methods?
How can the Z-CAN program be replicated in other clinics in Puerto Rico?
Do you have any other thoughts or comments you would like to share? Is there anything else?
CLOSING: Thank you for your time.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Zapata, Lauren (CDC/ONDIEH/NCCDPHP) |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |