title: Exploring Provider Perspectives as Barriers and Facilitators to Implementation of Quality Family Planning Recommendations at Title X Clinics: A Qualitative Study.
abstract: In 2014, the Centers for Disease Control and Prevention and the Office of Population Affairs released a document entitled Providing Quality Family Planning Services (QFP), which outlined recommendations for delivery of family planning services using a client-centered approach. These aimed to standardize service provision and address numerous reproductive health challenges. To date, little is known about QFP implementation or the factors influencing its adoption by clinicians.
  
  
  
  Semistructured interviews were conducted with 16 family planning providers at Title X-funded clinics in Indiana and Missouri to measure provider attitudes toward the QFP, their influence on adoption of the recommendations, and other barriers to QFP implementation. Interviews were transcribed verbatim and analyzed in Nvivo. Using the diffusion of innovation theory as a framework, we identify themes related to innovation adoption.
  
  
  
  Findings suggest that a provider's values related to client-centered counseling and views regarding the relative advantage of the QFP are key factors influencing adoption. Participants identified a number of structural and interpersonal barriers to implementation including misinterpretation of the QFP and billing issues.
  
  
  
  Although participants expressed that QFP was an improvement over previous guidelines, misalignment of the recommendations with professional values and experiences, lack of clarity of the guidelines, and logistical issues serve as major barriers to adoption and implementation. These findings inform our understanding of policy adoption. Increased training and precise messaging is necessary to improve adoption of QFP at Title X clinics.
authors.affiliation: Department of Applied Health Science, Indiana University-Bloomington School of Public Health, Bloomington, Indiana; Rural Center for AIDS/STD Prevention, Indiana University-Bloomington, Bloomington, Indiana; The Kinsey Institute, Indiana University-Bloomington, Bloomington, Indiana. Electronic address: mksimmon@indiana.edu.
authors.forename: Megan
authors.initials: M
authors.lastname: Simmons
authors.affiliation: Department of Applied Health Science, Indiana University-Bloomington School of Public Health, Bloomington, Indiana.
authors.forename: Lucia
authors.initials: L
authors.lastname: Guerra-Reyes
authors.affiliation: Department of Applied Health Science, Indiana University-Bloomington School of Public Health, Bloomington, Indiana; Rural Center for AIDS/STD Prevention, Indiana University-Bloomington, Bloomington, Indiana.
authors.forename: Beth
authors.initials: B
authors.lastname: Meyerson
authors.affiliation: Indiana Family Health Council, Indianapolis, Indiana.
authors.forename: Kristin
authors.initials: K
authors.lastname: Adams
authors.affiliation: Department of Applied Health Science, Indiana University-Bloomington School of Public Health, Bloomington, Indiana; Rural Center for AIDS/STD Prevention, Indiana University-Bloomington, Bloomington, Indiana; The Kinsey Institute, Indiana University-Bloomington, Bloomington, Indiana; Department of Gender Studies, Indiana University-Bloomington, Bloomington, Indiana.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Sanders
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005193:Family Planning Services / Q000331:legislation & jurisprudence; D005260:Female; D006284:Health Plan Implementation / Q000458:organization & administration*; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D018802:Patient-Centered Care; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D011787:Quality of Health Care