Individuals with substance use disorder (SUD) and higher rates of unintended pregnancies could benefit from a family planning intervention targeted for that population.1

“I’ve worked for many years in research for HIV prevention and substance use treatment. I was interested in making sure that women experiencing substance use disorder have access to knowledge and empowerment to make decisions on their reproductive health,” says Deborah J. Rinehart, PhD, associate research scientist with the Center for Health Systems Research at the Denver Health and Hospital Authority. Rinehart also is an associate professor of medicine in the division of general internal medicine at the University of Colorado Anschutz Medical Campus.

“The concept of using a peer was something that we thought might be salient in this work. We kind of had that idea when we wrote the grant proposal,” she says. “We did qualitative interviews, and women endorsed that they would feel comfortable talking about this topic with someone who gets where they’re coming from and what they’re going through.”

The peer-led family planning navigation intervention employed women who were successful in connecting with study participants. The healthcare organization has a robust integration for Title X and family planning in its healthcare facilities.

“We have, in our ambulatory care services, Title X funding, and we have set up a really great system in most of our federally qualified health centers [FQHCs],” Rinehart explains. “Health educators are embedded in the clinic and work alongside providers so we’re able to get people in quickly. They have more time to talk to educators about their particular needs.”

Using health educators has helped patients learn about contraceptive methods and obtain their method of choice in the same day.

“If a patient wants to leave here with an implant, they can have the provider pop in and give them an implant,” Rinehart says. “What we really need to think about is the generalizability of this kind of work, so we need a navigator/health educator intervention.”

The goal is to provide education to women and navigate them to clinical services as needed. “We call it a peer navigator,” she says. “We developed a step-by-step manual so that anyone could deliver the intervention.”

Navigators deliver the intervention on their own, but it is designed through support training to be consistent, Rinehart explains. Researchers recruited people into the study and randomized them so that half of the study participants got to work with a peer navigator. Peer navigators met with the women and conducted a standardized intervention that included motivational interviewing techniques.

“We developed an educational pamphlet with this population in focus groups because one of the things we found in doing some of our qualitative work was this concept that the women in treatment felt that they wanted to know a lot about the different methods of contraception so they could make an informed choice,” Rinehart says.

The women had fluid ideas regarding whether they wanted to prevent pregnancy. “We started the conversation by asking if they wanted a pregnancy within the next year,” Rinehart says. “If they did, we told them to talk with someone about prenatal care and planning for a pregnancy. If they did not, then we offered them some contraceptive options.”

Researchers created educational materials that offered all the necessary information, including listing various contraceptive methods. The women sought information about when their fertility would return after they stopped taking contraceptives. They also asked about side effects and what they had to do for the various methods, Rinehart notes.

Asking about the women’s pregnancy intentions in the next year was the key question that was used to start the reproductive health conversation. Peer educators screened women for nicotine use because it could be a contraindication for some birth control medications. They also determined women’s contraceptive intentions and whether they wanted to meet with a clinician.

The first sessions with peer educators were kept short with the goal of helping women feel comfortable and engaged, Rinehart adds.

“We’re really just providing choices with someone having the time to work through what the different contraceptive methods are and connecting women with them so they feel respected and empowered,” she says. “There’s a lot of trauma in this population, so having that connection and respect is important.”

REFERENCE

  1. Rinehart DJ, Stowell M, Collings A, et al. Increasing access to family planning services among women receiving medications for opioid use disorder: A pilot randomized trial examining a peer-led navigation intervention. J Subst Abuse Treat 2021;126:108318.