Implementing SINC (Self-Identified Need for Contraception) screening: A mixed methods case study

This mixed-methods case study examined implementation of an adapted Self-Identified Need for Contraception (SINC) screening for all genders aged 12-44 in four Cambridge Health Alliance (CHA) primary care sites. We focused on assigned-male-at-birth (AMAB) patients, who are not typically exposed to routine opportunities to discuss contraception. We explored these study questions: How did screening rates vary over time by site and patient characteristics (sex, age and language)?; What did healthcare staff perceive as facilitators or challenges to implementation?; and how acceptable was adapted-SINC screening to AMAB patients?

We estimated mixed effects models to analyze electronic health record (EHR) data on screening and need rates by site, sex, age, and language. We conducted interviews with CHA staff (n = 11) across two time points about implementation, and with AMAB patients (n = 28) about experiences and acceptability of screening. We used a convergent design, analyzing EHR and interview data in parallel and integrating findings.

By quarter 4 (9-12 months after screening initiation) adjusted screening rates were significantly higher than quarter 1. At 15-18 months, unadjusted (raw) rates ranged from 39.0% to 79.0% by site and were 56.4%/44.6% for assigned-female-at-birth/AMAB patients. Interviews revealed key learnings about implementation facilitators. Both staff and AMAB patients found screening manageable, acceptable, and beneficial. All patient interviewees reported comfort with screening.

Findings provide actionable guidance for SINC implementation, including strategies to build buy-in, increase adoption, anticipate barriers, adapt workflows, and establish realistic timelines. Screening likely helped normalize contraceptive care and identify unmet contraceptive needs.

Implementing an adapted version of SINC screening in primary care with patients of all genders ages 12-44 was manageable and acceptable to staff and AMAB patients. The study contributes original insights from AMAB patients. This adapted-SINC likely helped normalize contraceptive care and surface unmet needs. Findings offer actionable guidance for organizations seeking to implement SINC.