title: Improving contraceptive choice: fidelity of implementation and the gap between effectiveness and efficacy.
abstract: Interventions to reduce unintended pregnancy through improved contraceptive use are a public health priority. A comprehensive process evaluation of a contraceptive assessment module intervention with demonstrated efficacy was undertaken. The 12-month process evaluation goal was to describe the extent to which the intervention was implemented as intended over time, and to identify programmatic adjustments to improve implementation fidelity. Quantitative and qualitative methods included staff surveys, electronic health record data, usage monitoring, and observations. Fidelity of implementation was low overall (<10% of eligible patients completed the entire module [dose received]). Although a midcourse correction making the module available in clinical areas led to increased dose delivered (23% vs. 30%, chi-square test p = .006), dose received did not increase significantly after this adjustment. Contextual factors including competing organizational and staff priorities and staff buy-in limited the level of implementation and precluded adoption of some strategies such as adjusting patient flow. Using a process evaluation framework enabled the research team to identify and address complexities inherent in effectiveness studies and facilitated the alignment of program and context.
authors.affiliation: Public Health Solutions, New York, NY, USA sgarbers@healthsolutions.org.
authors.forename: Samantha
authors.initials: S
authors.lastname: Garbers
authors.affiliation: City University of New York Graduate Center, New York, NY, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Flandrick
authors.affiliation: Public Health Solutions, New York, NY, USA.
authors.forename: Dayana
authors.initials: D
authors.lastname: Bermudez
authors.affiliation: Public Health Solutions, New York, NY, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Meserve
authors.affiliation: Public Health Solutions, New York, NY, USA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Chiasson
mesh_terms: D002755:Choice Behavior; D003151:Community Health Centers; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003270:Contraceptive Agents / Q000600:supply & distribution* / Q000627:therapeutic use; D004059:Diffusion of Innovation; D005260:Female; D006801:Humans; D020407:Internet; D009519:New York City; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D015397:Program Evaluation; D060728:Reproductive Health; D011795:Surveys and Questionnaires; D014584:User-Computer Interface
chemical_list: D003270:Contraceptive Agents
keywords: formative evaluation; internet/electronic interventions; process evaluation; reproductive health