Person: Holt, Kelsey
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Holt
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Kelsey
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Holt, Kelsey
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Publication A call for collaboration on respectful, person-centered health care in family planning and maternal health(BioMed Central, 2017) Holt, Kelsey; Caglia, Jacquelyn; Peca, Emily; Sherry, James M.; Langer, AnaBackground: Striking tales of people judged, disrespected, or abused in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) services are commonly exchanged among friends and families throughout the world while remaining sorely under-addressed in global health. Disrespect and abuse of individuals and providers in health services across the RMNCAH continuum must be stopped through collaborative, multi-tiered efforts. Call for collaboration A new focus on health care quality in the Sustainable Development Goals offers an opportunity to seriously reexamine user experiences and their impact on health care utilization. The new framework provides an opening to redress the insidious problem of negative interactions with care across the RMNCAH services continuum and redraft the blueprint for service delivery and performance measurement, placing individuals and their needs at the center. Both the maternal health and family planning fields are at a turning point in their histories of defining and addressing individuals’ experiences of care. In this commentary, we review these histories and the current state-of-the-art in both fields. Though the approaches and language in each sub-field vary, person-centered care principles related to the essential role of individuals’ preferences, needs and values, and the importance of informed decision-making, respect, privacy and confidentiality, and non-discrimination, are integral to all. Promoting respectful, person-centered care also requires recognizing the factors that lead to poor treatment of clients, including gender norms and unsupportive working conditions for providers. Lessons can be learned from innovative efforts across the continuum to support health care providers to provide respectful, person-centered care. Conclusion: Efforts in the maternal health and family planning fields to define respectful, person-centered care provide a useful foundation from which to connect across the continuum of RMNCAH services. Now is the time to creatively work together to develop new approaches for promoting respectful treatment of individuals in all RMNCAH services.Publication Measuring the Quality of Reproductive Health Services in Mexico and the United States(2017-01-20) Holt, Kelsey; McCormick, Marie C.; Langer, Ana; Lieberman, ElliceA focus on quality of care in health services is important from both public health and human rights perspectives. From a public health perspective, a central premise underlying quality improvement work is that improving quality, including interpersonal aspects of care, will lead to better health outcomes. Good communication between providers and patients in various areas of health care has been shown to be highly correlated with adherence to treatment. From a human rights perspective, the Right to Health, as established by the United Nations Committee on Economic, Social, and Cultural Rights, entitles all people to healthcare information, services, and commodities that are available, accessible, acceptable, and of good quality. Avedis Donabedian’s foundational framework specifies three dimensions for the assessment of the quality of medical care: structure (attributes of material resources, human resources, and organizational structure); process (actual care given and received); and outcome (health, behavior, knowledge, satisfaction effects of the processes of care). This dissertation is grounded in Donabedian’s framework and focused on the assessment of process dimensions of care, specifically the nature of health care providers’ communication with women about sexual and reproductive health issues. Both technical and interpersonal elements of health care provider performance, as described by Donabedian, are integral to good communication with patients and are touched upon in the dissertation. The papers of this dissertation contribute to understanding the quality of physician-patient interactions in sexual and reproductive health services in the United States and improving measurement of individuals’ experiences with contraceptive care in Mexico. Papers 1 and 3 are quantitative analyses of nationally representative survey data on United States primary care physicians’ training, practices, and opinions related to providing pregnancy options counseling and referrals for unintended pregnancy (Paper 1) and information and counseling related to a number of preventive services for women of reproductive age (Paper 3). Paper 2 focuses on developing a new scale to measure women’s experiences with contraceptive counseling in Mexico. This paper includes conceptual development of a measurement framework (Part A) and formative qualitative research with contraception clients to develop the scale’s item pool and ensure content validity (Part B).Publication A nationally representative survey of healthcare provider counselling and provision of the female condom in South Africa and Zimbabwe(BMJ Publishing Group, 2013) Holt, Kelsey; Blanchard, Kelly; Chipato, Tsungai; Nhemachena, Taazadza; Blum, Maya; Stratton, Laura; Morar, Neetha; Ramjee, Gita; Harper, Cynthia CObjectives: Female condoms are the only female-initiated HIV and pregnancy prevention technology currently available. We examined female condom counselling and provision among providers in South Africa and Zimbabwe, high HIV-prevalence countries. Design: A cross-sectional study using a nationally representative survey. Setting: All facilities that provide family planning or HIV/sexually transmitted infection (STI) services. Participants: National probability sample of 1444 nurses and physicians who provide family planning or HIV/STI services. Primary and secondary outcome measures Female condom practices with different female patients, including adolescents, married women, women using hormonal contraception and by HIV status. Using multivariable logistic analysis, we measured variations in condom counselling by provider characteristics. Results: Most providers reported offering female condoms (88%; 1239/1415), but perceived a need for novel female barrier methods for HIV/STI prevention (85%; 1191/1396). By patient type, providers reported less frequent female condom counselling of adolescents (55%; 775/1411), women using hormonal contraception (65%; 909/1409) and married women (66%; 931/1416), compared to unmarried (74%; 1043/1414) or HIV-positive women (82%; 1161/1415). Multivariable results showed providers in South Africa were less likely to counsel women on female condoms than in Zimbabwe (OR=0.48, 95% CI 0.35 to 0.68, p≤0.001). However, South African providers were more likely to counsel women on male condoms (OR=2.39, 95% CI 1.57 to 3.65, p≤0.001). Nurses counselled patients on female condoms more frequently than physicians (OR=5.41, 95% CI 3.26 to 8.98, p≤0.001). HIV training, family planning training, location (urban vs rural) and facility type (hospital vs clinic) were not associated with greater condom counselling. Conclusions: Female condoms were integrated into provider counselling and care, although providers reported a need for new female-initiated multipurpose prevention technologies, suggesting female condoms do not meet all patient/provider needs or are not adequately well known or accessible. Providers should be included in HIV training efforts to raise awareness of new and existing products, and encouraged to educate all women.