SUPPORTING STATEMENT - PART A
Military Health System Providers’ Attitudes Towards and Knowledge of Contraceptive Care and Women’s Reproductive Health – 0720-WRHS
1. Need for the Information Collection
Health care provider knowledge, beliefs, and practices may have an impact on active-duty service women’s (ADSW) access to contraception and overall reproductive health. Existing surveys of Military Health System (MHS) providers on these issues are limited to studies of small, convenience samples of specific branches. Nonetheless, they suggest that some gaps in knowledge, training, and provision of services may exist. These provider reports are generally in line with previous surveys of ADSW (e.g., the DoD Women’s Reproductive Health Survey [WRHS]) indicating that they did not receive counseling regarding contraception or menstrual suppression prior to deployment, were provided an inadequate supply of contraceptives, or were unable to access contraception during deployment. However, the picture these existing studies provide is incomplete and inconsistent, as they are not based on representative samples.
The proposed survey is devised to be a sufficiently large and representative sample of the diverse professionals who provide reproductive and contraceptive care to ADSWs at health care visits (e.g., readiness visits, pre-deployment, and during deployment). The survey will be designed to capture provider self-reported beliefs, clinical knowledge on reproductive health care (including contraceptive counseling) and prescribing and providing contraception care for and during deployment. Data and analysis from the survey will enable DoD to evaluate, enhance, and where needed, improve reproductive services delivery and educational interventions; provide a strong basis for planning policy and services related to ADSWs’ reproductive and contraceptive health; and provide data, programs, and details necessary for replication and peer review.
In addition, the proposed one-time survey meets a Congressional mandate and serves as an appropriate follow-up to the WRHS by determining whether identified gaps in contraceptive access are the result of provider knowledge and attitudes. The 116-48 SASC Report for NDAA FY20, Section “Survey to determine providers’ attitude towards contraceptive services, their knowledge on obligations to dispense and counsel on contraception and assess potential cultural barriers to providing contraceptive services” required DoD to conduct a survey to better understand provider knowledge and beliefs related to provision of contraceptives to ADSW (https://www.congress.gov/116/crpt/srpt48/CRPT-116srpt48.pdf).
A signed project description is included in this information collection request.
2. Use of the Information
The target population of the survey includes all uniformed (active component only) and civilian Military Health System (MHS) personnel who were employed in the most currently available data. Approximately 15,200 providers will be invited to participate by both mail and email, with mail, email, and phone reminders sent to non-responders only. All participants will receive the same survey instrument, which uses skip patterns to identify which items are appropriate for which respondents (e.g., medical doctors versus nurses).
The survey, which is web-based and can be taken on a desktop, laptop, or mobile device (e.g., smartphone, tablet) should take approximately 15-20 minutes to complete. As a conservative estimate, we have used 20 minutes in the burden estimates in Section 12 of this Supporting Statement. Each respondent receives a unique identification code which will allow him/her to take the survey at a specified website. Consent will be obtained electronically prior to a respondent beginning the survey; the consent form can be printed by the respondent. Any item in the survey can be skipped should the respondent choose to do so.
Once a respondent is finished, he/she submits the survey electronically. The survey will be administered by a survey vendor that is still to be determined. A minority of surveys (<5%) may be completed via phone, with the survey vendor. These completions will be merged with survey completed via the internet. The survey vendor will maintain and clean the responses and provide RAND with a final dataset. We expect roughly 2,100 completed surveys.
The survey instrument, sample communications (postal letters, emails, phone script), FAQs, consent and close language, and IRB approvals are included in this information collection request package for OMB review.
3. Use of Information Technology
The survey is web-based. It is expected that 90-95% of responses will be collected electronically. To increase response rates, the survey vendor will also offer an option to complete the survey by phone should a respondent prefer that mode. The phone completion option will only be available to non-respondents who receive a phone reminder call.
4. Non-Duplication
The information obtained through this collection is unique and is not already available for use or adaptation from another cleared source.
5. Burden on Small Businesses
This information collection does not impose a significant economic impact on a substantial number of small businesses or entities.
6. Less Frequent Collection
This is a one-time data collection effort. If the data is not collected, it will not exist and DoD will not be able to use representative data from MHS providers data to better understand where there may be gaps in the awareness of ADSW’s needs with respect reproductive health, access to contraceptives, comfort with provision of services, and awareness of policies related to access of reproductive health care.
7. Paperwork Reduction Act Certification
This collection of information does not require collection to be conducted in a manner inconsistent with the guidelines delineated in 5 CFR 1320.5(d)(2).
8. Solicitation of Comments
Part A: PUBLIC NOTICE
A 60-Day Federal Register Notice (FRN) for the collection published on Tuesday, January 9, 2024. The 60-Day FRN citation is 89 FRN 1084.
No comments were received during the 60-Day Comment Period.
A 30-Day Federal Register Notice for the collection published on Wednesday, June 26, 2024. The 30-Day FRN citation is 89 FRN 53401
Part B: CONSULTATION
No additional consultation apart from soliciting public comments through the Federal Register was conducted for this submission.
9. Gifts or Payment
Participants who complete the survey will be offered an e-gift card in the amount of $40. Per DoD regulations, those who complete the survey must attest that they completed the survey outside of duty hours. Compensation for participation is being used because surveys of health care professionals generally have lower response rates than surveys of the general population.
10. Confidentiality
A Privacy Act Statement is not required for this collection because we are not requesting individuals to furnish personal information for a system of records.
A System of Record Notice (SORN) is not required for this collection because records are not retrievable by PII.
A Privacy Impact Assessment (PIA) is not required for this collection because PII is not being collected electronically.
As applicable, records will be maintained in accordance with the following records disposition schedules:
FILE NUMBER: 905-02
FILE TITLE: Quality Assurance Studies and Analyses of Healthcare Quality Standards
FILE DESCRIPTION: Files pertaining to the quality assurance analysis of DoD, other federal agency, State and local, and other healthcare standards including studies and analyses that result in issuance of new standards.
DISPOSITION: Permanent. Cut off upon completion of standard. Transfer to NARA 25 years after cutoff.
AUTHORITY: NC1-330-77-005, item 905-02a and 905-02c
FILE NUMBER: 905-03
FILE TITLE: Ad Hoc Quality Assurance Studies and Analyses of Healthcare Quality
FILE DESCRIPTION: Studies and evaluations on a "when required" basis, not resulting in issuance of new standards.
DISPOSITION: Temporary. Cut off upon completion of study. Destroy 5 years after cutoff.
AUTHORITY: NC1-330-77-005, item 905-02b
11. Sensitive Questions
The survey contains some items about provider comfort with providing reproductive health care services that they may have moral, religious, or other objections. Some providers may find these questions to be sensitive in nature. The point of the data collection effort is to understand provider attitudes towards and comfort these services and procedures. Similar survey items have been used in surveys of civilian providers. The survey is confidential, and responses will never be linked to an individual. RAND will obtain a Certificate of Confidentiality from the National Institutes of Health (NIH).
12. Respondent Burden and its Labor Costs
Part A: ESTIMATION OF RESPONDENT BURDEN
Collection Instrument(s)
Women’s Reproductive Health Care Provider Survey (WRHCPS)
Number of Respondents: 2,129
Number of Responses Per Respondent: 1
Number of Total Annual Responses: 2,129
Response Time: 20 minutes
Respondent Burden Hours: 709.67 hours
Total Submission Burden (Summation or average based on collection)
Total Number of Respondents: 2,129
Total Number of Annual Responses: 2,129
Total Respondent Burden Hours: 710 hours
Part B: LABOR COST OF RESPONDENT BURDEN
Collection Instrument(s)
Women’s Reproductive Health Care Provider Survey (WRHCPS)
Number of Total Annual Responses: 2,129
Response Time: 20 minutes
Respondent Hourly Wage: $53.09 (This is an average. See tables at the end of this section for breakdown by provider type.)
Labor Burden per Response: $17.70 (This is an average. See tables at the end of this section for breakdown by provider type.)
Total Labor Burden: $37,676.20
Overall Labor Burden
Total Number of Annual Responses: 2,129
Total Labor Burden: $37,676
The respondent hourly wage was determined by using the [Bureau of Labor Statistics Wage Estimate Website] ([https://www.bls.gov/oes/current/oes_nat.htm]) and, for enlisted medical personnel, the participant/respondent hourly wage was determined by using the 2023 Active Duty Pay Table (https://www.military.com/benefits/military-pay/charts).
The below tables show the estimated respondent hourly wages broken down by Provider Type, as well as their labor burden per response. The third table shows the expected number of respondents for each Provider Type. These are the estimates used to come up with the averages and totals computed above.
Provider Type |
Hourly Rate |
OB/Gyn |
$133.33 |
Other MD |
$121.15 |
Nurse practitioner |
$59.94 |
Other nurses |
$42.80 |
Physician’s Asst. |
$60.23 |
Enlisted Med. Personnela |
$19.75 |
a Based on a E5 with 6 years of experience. |
|
Provider Type |
Labor Burden Per Response |
OB/Gyn |
$44.44 |
Other MD |
$40.38 |
Nurse practitioner |
$19.98 |
Other nurses |
$14.27 |
Physician’s Asst. |
$20.08 |
Enlisted Med. Personnel |
$6.58 |
Provider Type |
Expected # of Respondents |
Total Labor Burden per Provider Type
|
OB/Gyn |
37 |
$1,644.40 |
Other MD |
265 |
$10,701.58 |
Nurse practitioner |
111 |
$2,217.78 |
Other nurses |
999 |
$14,252.40 |
Physician’s Asst. |
307 |
$6,163.54 |
Enlisted Med. Personnel |
410 |
$2,699.17 |
TOTAL |
2,129 |
$37,678.87 |
Respondent Costs Other Than Burden Hour Costs
There are no annualized costs to respondents other than the labor burden costs addressed in Section 12 of this document to complete this collection.
14. Cost to the Federal Government
Part A: LABOR COST TO THE FEDERAL GOVERNMENT
Collection Instrument(s)
Women’s Reproductive Health Care Provider Survey (WRHCPS)
Number of Total Annual Responses: 2,129
Processing Time per Response: 0 hours
Hourly Wage of Worker(s) Processing Responses: $0
Cost to Process Each Response: $0
Total Cost to Process Responses: $16,396.64
Overall Labor Burden to the Federal Government
Total Number of Annual Responses: 2,129
Total Labor Burden: $16,396.64
The above was calculated based on government oversight of the contract calculated as four hours per week for one GS-15. All processing is performed by RAND. These costs are captured in the contract cost in Part B below.
Part B: OPERATIONAL AND MAINTENANCE COSTS
Cost Categories
Equipment: $0
Printing: $0
Postage: $0
Software Purchases: $0
Licensing Costs: $0
Other: The total cost of the contract supporting this survey is $1,500,000.
Total Operational and Maintenance Cost: $1,500,000.
Part C: TOTAL COST TO THE FEDERAL GOVERNMENT
Total Labor Cost to the Federal Government: $16,396.64
Total Operational and Maintenance Costs: $1,500,000.00
Total Cost to the Federal Government: $1,516,396.64
Reasons for Change in Burden
This is a new collection with a new associated burden.
Publication of Results
The results of this information collection are intended to be published as a peer-reviewed RAND publication. The projected title of publication is Military Health Care Providers Attitudes Towards and Knowledge of Contraceptive Care and Active Duty Service Women’s Reproductive Health. Data collection is expected to occur as soon as possible following the receipt of all necessary approvals. Data analysis, final report writing, and peer/sponsor reviews will occur in the months following data collection.
17. Non-Display of OMB Expiration Date
We are not seeking approval to omit the display of the expiration date of the OMB approval on the collection instrument.
18. Exceptions to “Certification for Paperwork Reduction Submissions”
We are not requesting any exemptions to the provisions stated in 5 CFR 1320.9.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Kaitlin Chiarelli |
| File Modified | 0000-00-00 |
| File Created | 2024-07-21 |