How can Primary Care Physicians Best Support Contraceptive Decision Making? A Qualitative Study Exploring the Perspectives of Baltimore Latinas.

OBJECTIVES: U.S. Latinas experience disproportionately high rates of unintended pregnancy and low rates of consistent contraception use. Not well known are Latinas' perspectives about how primary care physicians (PCPs) might facilitate or deter contraceptive decision making. The theory of planned behavior has been used previously to explain contraceptive behaviors. This study used the theory of planned behavior as a guide to help describe Latinas' perspectives regarding specific factors that influence their contraceptive decision making and to describe their perspectives about the role of PCPs in the decision making. STUDY DESIGN AND METHODS: We conducted focus groups (n = 3) and interviews (n = 8) of Latinas ages 15 to 24 years, recruited from urban primary care sites in Baltimore, Maryland. Concepts from the theory of planned behavior were used to develop a coding scheme and guide identification of themes. RESULTS: Sixteen Latinas participated; all were immigrants. THEMES: The desire to avoid unintended pregnancy is dominant and, not surprisingly, is the main driver of contraceptive intentions. The role of PCPs in contraceptive decision making is to build strong patient relationships through heightened communication and trust. PCPs should develop trust and foster communication by using a shared decision-making approach in contraceptive counseling. Religious norms rarely operate as barriers to contraceptive use, yet positive reinforcement from family, friends, and schools is viewed as supportive. CONCLUSIONS AND IMPLICATIONS: For this group of young, immigrant Latinas, there is a pervasive desire for effective communication and trusting relationships with PCPs. Findings suggest that providers can facilitate contraceptive decision making for this population by using a shared decision-making approach to contraceptive counseling.

Addressing the challenges of Latino health research: participatory approaches in an emergent urban community.

BACKGROUND: Challenges to recruitment of Latinos in health research may include language, cultural and communication barriers, trust issues, heterogeneity of legal status, and a high percent of uninsured when compared to the US population. This paper highlights the community-based participatory research (CBPR) process and expands on the applicability of these principles to Latino communities. METHODS: We review steps taken and describe lessons learned in using a participatory approach to broadly assess and address the health of urban-dwelling Latinos in Baltimore, Maryland, through the adaptation of CBPR principles. FINDINGS: We identified health priorities, access barriers, and community resources (eg, Latin American trained nurses who were not currently working in the health field, immigrant networks) using a participatory approach. Suggestions for improving trust, research participation, and access to care ranged from not collecting data on legal status, and regular attendance and presentations of ongoing research at community provider meetings, to referral to free or low-cost health care services at screening events. CONCLUSION: Despite growing interest in CBPR, limited guidance exists on how to apply CBPR principles to conduct health research among Latinos. Incorporating a participatory process can help address Latino community concerns, enrich quality and relevance of research, and empower community members.

A vision for progress in community health partnerships.

Community-based participatory research (CBPR) is an increasingly used approach for conducting research to improve community health. Using Rogers' diffusion of innovations theory as a framework, it follows that future adoption of CBPR will occur if academic and community partners perceive CBPR to have greater relative advantage, compatibility, trialability, and observability, and less complexity than other research approaches. We propose that articles published in our new peer-reviewed journal--Progress in Community Health Partnerships: Research, Education, and Action (PCHP)--can influence academic and community partners' perceptions of CBPR that promote its adoption. Eight areas of scholarly activity are described that can promote health partnership research, education, and action: (1) original research, (2) work-in-progress and lessons learned, (3) policy and practice, (4) theory and methods, (5) education and training, (6) practical tools, (7) systematic reviews, and (8) community perspectives. These eight areas correspond with the eight main sections of PCHP. A brief description of each area's importance in promoting CBPR is provided along with examples of completed and ongoing work. Specific recommendations are made regarding issues, problems, and topics within each area on which CBPR work should focus. These recommendations, which present a vision for progress in community health partnerships, are based on idea generation and prioritization by a group of CBPR experts--PCHP's editors and editorial board.

Guidelines for writing manuscripts about community-based participatory research for peer-reviewed journals.

Despite the importance of disseminating the results of community-based participatory research (CBPR), community health partnerships face many challenges in getting their work published. The purpose of this article is to present practical guides for writing about CBPR for those who have little experience in writing for publication or those who want to help their partners write strong manuscripts for peer-reviewed journals. The article includes tips on how to organize each part of a manuscript, suggestions on how partners can collaborate on preparing manuscripts, recommendations on how to convey unique aspects of a partnership's work throughout a manuscript, and an annotated bibliography of well-written CBPR articles. By understanding how to prepare a manuscript about CBPR for a peer-reviewed journal, authors should be more effective in disseminating information that will help other communities to benefit from their partnership's work.