Feasibility and acceptability of a toolkit-based process to implement patient-centered, immediate postpartum...

Area of Science:

• Reproductive Health
• Healthcare Implementation Science
• Maternal Care Quality Improvement

Background:

• National guidelines advocate for immediate postpartum long-acting reversible contraception (IP-LARC) during delivery hospitalizations.
• Hospitals encounter substantial barriers to offering IP-LARC, with varied success in improving peripartum contraceptive care.
• Implementation toolkits offer a structured approach to facilitate the adoption of new clinical services.

Purpose of the Study:

• To develop a theory-informed toolkit for implementing immediate postpartum long-acting reversible contraception (IP-LARC).
• To assess the feasibility of using the toolkit for IP-LARC implementation at a single academic medical center.
• To refine the toolkit and implementation strategy based on feasibility study outcomes for future effectiveness testing.

Main Methods:

• A single-site feasibility study conducted at a large academic medical center from 2017-2020.
• Development of a theory-informed implementation toolkit based on prior qualitative research.
• A multicomponent intervention using selected toolkit resources to optimize implementation conditions, followed by outcome assessment via provider surveys, administrative data, and patient surveys.

Main Results:

• Provider satisfaction with the implementation process was high (70% satisfied).
• Documented prenatal contraceptive counseling rates increased significantly throughout 2019 (12.5% to 51.0%), though clinic site variation persisted.
• Immediate postpartum long-acting reversible contraception utilization showed an increase during the study period (5.46% to 8.95%), with patient experience scores showing modest improvements in the hospital setting.

Conclusions:

• A toolkit-based approach to implementing immediate postpartum long-acting reversible contraception services demonstrated high acceptability but yielded mixed healthcare quality outcomes.
• Toolkit resources were enhanced to improve counseling rates and the patient experience of contraceptive care.
• Further research is recommended to formally evaluate the refined toolkit's effectiveness in a multisite, prospective trial.