Responsive design, local realities: A process evaluation of Family Planning Elevated

While the ability of contraceptive initiatives to improve access has been established, less is known about the process of implementing them within health settings. To address this gap, we conducted a process evaluation of Family Planning Elevated (FPE), a statewide contraceptive initiative in Utah.

FPE partnered with 28 clinics to provide no-cost contraceptive care to individuals across Utah. We conducted a mixed methods process evaluation to document how FPE was implemented, how surrounding context affected the implementation, and the mechanisms by which FPE created impact. Our primary data sources were baseline, midline, and endline focus groups with clinic staff, which we analyzed using the Consolidated Framework for Implementation Research and qualitative longitudinal analysis.

Our evaluation yielded six themes: Utah's reproductive health landscape (1) and the Covid pandemic (2) significantly impacted FPE's implementation, (3) FPE's adaptability was crucial to successful implementation, (4) structural characteristics of clinics were a common barrier to implementation, (5) clinic partners were motivated to participate in FPE, despite its complexity, because of the benefit to their clients and (6) provider perspectives and organizational culture became more person-centered during FPE.

Findings from FPE's process evaluation point to the importance of designing a program that is adaptable to shifting local, state, and national context, as well as to the unique needs of each clinic. Clinic partners were committed to expanding contraceptive access through FPE, and during their participation, clinic staff's perspectives shifted towards a more person-centered approach and culture.

Success of this initiative was driven by the ability of the FPE program to tailor the intervention to meet unique clinic and community needs, and by the commitment of clinic partners to expand contraceptive access for their clients.