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  • Title: Tailoring family planning services to the special needs of adolescents.
    Author: Winter L, Breckenmaker LC.
    Journal: Fam Plann Perspect; 1991; 23(1):24-30. PubMed ID: 2029940.
    Abstract:
    Experimental service protocols tailored to the needs of teenage family planning patients were developed that emphasized indepth counseling, education geared to an adolescent's level of development, and the provision of reassurance and social support. These protocols were tested against usual service delivery practices in a study involving 1,261 patients under 18 years of age at six nonmetropolitan family planning clinics. A comparison with teenagers obtaining services at control sites found that six months after their first clinic visit, patients at the experimental sites were more likely to be using a method, were less likely to experience difficulty in dealing with problems, were more likely to continue using their method despite problems and had learned more during the educational session. Teenage patients at the experimental clinics were also less likely to have become pregnant within one year than those who went to control clinics. Attrition during the year following the first study visit was similar among both groups; patient satisfaction was very high, and equivalent at experimental and control sites. The data show that the extra time and effort required to meet the special needs of teenagers is justified by their improved contraceptive use, greater knowledge and lower pregnancy rates. The results provided in this evaluation study of teenage family planning (FP) services pertain to 3 components of intervention: the knowledge patients acquired, their feelings about the clinic, and their FP experiences (contraceptive use, clinic attendance, and unintended pregnancy). Instruments were designed to specifically measure the aforementioned components, and a full description of the instruments is provided. A Cronbach's alpha of .84 revealed high internal consistency on the Satisfaction Scale, and factor analysis indicated the scale functioned as a unified construct. The Knowledge Quiz showed the reverse pattern. A pretest/posttest was implemented to differentiate exposed and nonexposed nonrandomly selected patients from 6 teenage FP clinics. Patients included both returning as well as 1st time patients. Information was collected for 1 year after each patient's index visit. The intervention per the experimental protocol tool place over a 6-month period. Sites were selected that were similar in patient characteristics and staff patterns, with the exception that control sites had slightly higher continuation rates and experimental sites had more 1st time patients. 1261 were involved in the study of which 518 were in the experimental group. 251 were enrolled during the baseline period of which 93 were in the experimental group. 98% of the clinic patients were white, and 40% were 17 years, 34% were 16 years, and 16% were 15 years. 22% were Roman Catholic. A description of the program development revealed that the experimental protocols were developed in committee. A Personal Information Form was generated to assess the reasons for the visit, feelings about the clinic, sexual and contraceptive history, and parental and partner approval about visiting the clinic or obtaining contraception. 1 critical points were identified as critical in a total service delivery system for adolescents. Baseline and treatment phase comparison findings are presented as well as treatment phase comparisons. The findings were supportive of an FP approach which attends to psychosocial needs for adolescents. The most dramatic affect of the intervention was in contraceptive use. Patients at experimental sites returning for their 6-month visit were more likely to be continuing the original method at 6 months, experienced greater ease in coping with problems, stayed with the method regardless of problems, and had a lower pregnancy rate than controls. At 12 months the differences with the control group narrowed for continuing use. Quiz scores and satisfaction scores were also higher at experimental sites. Future suggestions are to drop the satisfaction test and the no show or continuation report, and to streamline the research design and include black and Hispanic teenagers.
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