Comparison of patient flow and provider efficiency of two delivery strategies for HPV-based cervical cancer screening in Western Kenya: a time and motion study.

BACKGROUND: Improving patient flow and reducing over-crowding can improve quality, promptness of care, and patient satisfaction. Given low utilization of preventive care in low-resource countries, improved patient flows are especially important in these settings. OBJECTIVE: Compare patient flow and provider efficiency between two cervical cancer screening strategies via self-collected human papillomavirus (HPV). METHODS: We collected time and motion data for patients screened for cervical cancer in 12 communities in rural Migori County, Kenya as part of a larger cluster randomized trial. Six communities were randomized to screening in community health campaigns (CHCs) and six to screening at government clinics. We quantified patient flow: duration spent on each active stage of screening and wait times, and the number of patients arriving at CHCs and clinics each hour of the day. In addition, for four CHCs, we collected time and motion data for providers, and measured provider efficiency as a ratio of active (service delivery) time to total time spent at the clinic. RESULTS: Total duration of screening visits, at CHCs and clinics was 42 and 87 minutes, respectively (p < 0.001 for difference). Total active time lasted longer at CHCs, with a mean of 28 minutes per patient versus 15 minutes at clinics, largely due to differences in duration for group education (p < 0.001). Wait time for registration at clinics was 36 minutes, explaining most of the difference between settings, but sometimes incorporated other health services. CONCLUSIONS: There is a substantial difference in patient flow at clinics compared to CHCs. Shorter duration at CHCs suggests that the model is favorable for patients in limiting time spent on screening. Future cervical cancer screening programs designed for scale-up should consider how this advantage may enhance satisfaction and uptake. For clinic-based screening programs, efforts could be made towards reducing registration wait times.

Information about Sexual Health on Crisis Pregnancy Center Web Sites: Accurate for Adolescents?

STUDY OBJECTIVE: The objective of this study was to evaluate the quality and accuracy of sexual health information on crisis pregnancy center Web sites listed in state resource directories for pregnant women, and whether these Web sites specifically target adolescents. DESIGN: A survey of sexual health information presented on the Web sites of crisis pregnancy centers. SETTING: Internet. PARTICIPANTS: Crisis pregnancy center Web sites. INTERVENTIONS: Evaluation of the sexual health information presented on crisis pregnancy center Web sites. MAIN OUTCOME MEASURES: Themes included statements that condoms are not effective, promotion of abstinence-only education, availability of comprehensive sexual education, appeal to a young audience, provision of comprehensive sexual health information, and information about sexually transmitted infections (STIs). RESULTS AND CONCLUSION: Crisis pregnancy center Web sites provide inaccurate and misleading information about condoms, STIs, and methods to prevent STI transmission. This information might be particularly harmful to adolescents, who might be unable to discern the quality of sexual health information on crisis pregnancy center Web sites. Listing crisis pregnancy centers in state resource directories might lend legitimacy to the information on these Web sites. States should be discouraged from listing Web sites as an accurate source of information in their resource directories.

Crisis pregnancy center websites: Information, misinformation and disinformation.

OBJECTIVE: Most states with 24-h waiting periods prior to abortion provide state resource directories to women seeking abortion. Our objective was to evaluate the information on abortion provided on the websites of crisis pregnancy centers listed in these resource directories. STUDY DESIGN: We performed a survey of the websites of crisis pregnancy centers referenced in state resource directories for pregnant women. We searched for these state-provided resource directories online. We contacted state Departments of Health and Human Services for a print copy when a directory could not be found online. The crisis pregnancy center websites were evaluated for the information provided on abortion. Standardized data collection tools were used. Descriptive statistics were generated. RESULTS: Resource directories of 12 states were procured. A total of 254 websites referring to 348 crisis pregnancy centers were identified. Overall, a total of 203/254 [80%, 95% confidence interval (CI) 75%-84%] of websites provided at least one false or misleading piece of information. The most common misleading or false information included on the websites were a declared link between abortion and mental health risks (122/254 sites; 48%, 95% CI 42%-54%), preterm birth (54/254; 21%, 95% CI 17%-27%), breast cancer (51/254; 20%, 95% CI 16%-25%) and future infertility (32/254; 13%, 95% CI 9%-17%). CONCLUSION: Most crisis pregnancy centers listed in state resource directories for pregnant women provide misleading or false information regarding the risks of abortion. States should not list agencies that provide inaccurate information as resources in their directories.