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Before women can obtain emergency contraception (EC), their health care providers must know about the method and be willing to prescribe it. Two West Coast projects coordinated by Population Services International (PSI), a Washington, DC-based nonprofit group, have focused on provider training as part of their strategy in improving EC access.
The projects, based in Sacramento, CA, and Portland, OR, have used different training models in educating providers about EC, but they are employing the same media campaign to raise awareness among their target audience: sexually active young women between the ages of 15 and 24. The programs began formative research and provider training in early 2000 and kicked off their media campaigns in November. While it is too early to access their impact, those involved with the program say they have had excellent response from providers and the community at large.
"Although our official evaluation data are not yet in, we do know that some of the major health care systems in the area who participated in the training are in the process of revising their protocols to facilitate easier access to EC," says Lorrie Harris-Sagaribay, MPH, project manager in Sacramento.
The Sacramento project is collaborating with the Los Angeles-based Pacific Institute for Women’s Health (PIWH) for its provider training. Led by PIWH consultant Debbie Postlethwaite, MPH, RNP, the program conducted six "train-the-trainer" workshops for 67 participants, including physicians, nurse practitioners, nurses, and health educators. The curriculum was designed to foster sensitivity about unintended pregnancy and also to focus on issues that were the most relevant for the providers, says Harris-Sagaribay.
Master trainers present material
The Portland project has worked with Seattle-based Program for Appropriate Technology in Health in developing its "master-trainer" pro-vider education model. The core of the educational model relies on a one-hour Microsoft PowerPoint computer program presentation, offered to clinical and nonclinical providers by a set of "master trainers." According to Portland project manager Alexandra Lowell, MPH, more than 500 have received education from the master trainers since the project began last year.
Research conducted prior to the program showed that while providers were eager to learn more about EC, they had busy schedules that often precluded training outside their normal business hours. The solution? PSI sets up the trainings so they coincide with facilities’ regular inservice sessions. By presenting the material in a time-effective manner at no cost to the organization, the organizations obtain free education, and more numbers are added to the pool of knowledgeable EC providers.
With providers prepared, the Sacramento and Portland projects have moved ahead with their media campaigns. The heart of the campaigns relies on radio advertisements, posters, and trifold wallet cards, all reinforcing the message, "Accidents happen — Pregnancy doesn’t have to." The wallet cards, printed in eye-catching pink and orange, are available in English and Spanish versions.
The material, developed by Slingshot Productions, an Oakland-based creative firm, answers women’s basic questions about ECPs and encourages them to talk with their health care providers or call the national Emergency Contraception Hotline [(888) NOT-2-LATE] for more information. By sharing the media development costs, the programs have been able to maximize their individual $75,000 budgets.
In addition to placing the material in such traditional areas as health care clinics and physicians’ offices, the programs also are putting material in neighborhood job training centers and other areas where young women congregate. The Portland program enlisted a local company, Water Closet Media, to place the posters in restrooms around the city, including those at a popular ski resort.
Break down barriers
While their respective communities have accepted both programs, those involved say there is more work to be done in breaking down the barriers to emergency contraception. For example, the Portland project is working toward increasing the number of pharmacies stocking Plan B, the progestin-only ECP marketed by the Women’s Capital Corp. of Bellevue, WA. Also, both programs are encouraging providers to consider prophylactic prescription of ECPs.
"That is one of the key messages we try to say, to [get providers to] talk about it now, rather than after the fact when a woman is fearing a risk of potential pregnancy and is in more of a crisis mode," says Lowell.
Organizations continue to impose barriers to EC by insisting on pregnancy testing and pelvic exams prior to EC provision, says Postlethwaite. Such restrictions not only make the service more difficult to deliver from a staff position, but are unnecessary, she states. The PSI program has made an impact, though, she contends.
"Providers have done trainings, changed guidelines, and changed protocols — we’re seeing that now," says Postlethwaite. "When we do the evaluation, we’ll see if provider practice has changed. I’m sure it has."