Providing comprehensive contraceptive services in primary care at a rural Federally Qualified Health Center in the USA: adapting to patient need in a culturally conservative, rural environment.

INTRODUCTION: In the USA, approximately 45% of pregnancies are unintended. Accessing quality contraceptives can be a barrier for some individuals, especially low-income, uninsured, minority or younger women. These problems are exacerbated in rural areas{1}. Integrating contraceptive services into primary care is an approach to ensure that sexually active women receive access to contraceptives. This study documented how one rural Federally Qualified Health Center (FQHC) adapted to their culturally conservative environment by offering contraceptive counseling, comprehensive education on birth control, and access to contraceptive services directly through primary care. METHODS: Twenty-one semi structured interviews were conducted and analyzed in Atlas.ti®. All women patients who had received contraceptive services through primary care in the previous 6 months were invited to participate in a semi-structured interview. A sample of current and past board members were invited to participate in semi-structured interviews. A sample of five primary care providers and nurses who interact with women receiving contraceptive services was invited to participate in a semi-structured, in-person interview. In addition, the executive director, the clinic manager, and the current and past medical directors were interviewed. A hybrid of inductive and deductive coding methods was used for theme generation. RESULTS: Interviews helped to highlight some of the barriers to accessing contraceptives currently experienced by women in this rural area, and showcased how this FQHC is adapting their approach and their services to be able to meet patient needs. The following themes emerged: lack of knowledge about services offered, lack of knowledge about birth control, misinformation and misconceptions, education on birth control, and care model. CONCLUSION: The cultural context of Southwest Virginia, including the cultural conservatism and stigma associated with talking about sex, has a big impact on people's willingness to access contraceptive services. Stigma limits educational opportunities being offered in schools, therefore limiting people's knowledge about services and birth control methods. This FQHC has adapted to their surrounding culture by ensuring that every woman seeking primary care at the FQHC is screened for contraceptive need, offered contraceptive counseling and comprehensive contraceptive methods. This FQHC's integration of contraceptive services is a model that can be replicated by other FQHCs, by local health departments, and by private physicians.

Inclusion Wheel: Tool for Building Capacity and Public Health Leaders to Serve People With Disabilities.

Public health leaders need to influence change to serve underserved populations, such as people who have a disability. Action research was conducted with a community of practice (CoP) from Ohio to examine readiness, capacity building, and capacity factors needed for public health partners to more fully include people who have a disability (PWD) in state smoking cessation efforts. Five conditions fostered readiness, capacity building, and capacity among public health partners to include PWD: (1) successful timing of effort, (2) facilitation of discussions, (3) systematic reflection, (4) sufficient support, and (5) personal commitment of participants. Nine factors of readiness, capacity building, and capacity influenced inclusion of PWD: (1) positive perception and quality interactions with partners, (2) contact with organizations, (3) recognition of need to coordinate, (4) engagement in a network, (5) practical collaboration experience, (6) continuing education, (7), critical reflection time, (8) dedicated staff, and (9) knowledge of priority population. Readiness, capacity, and capacity building were interconnected and supported inclusion of PWD in public health efforts. Ohio public health partners used these factors and conditions to achieve the first mandatory disability awareness training for all National Jewish Health Quitline counselors. Future efforts addressing other specific demographic groups that experience health disparities can use these findings.

Developing a Public Health Pipeline: Key Components of a Public Health Leadership Program.

Thirty percent of federal public health employees were retirement eligible in September 2017. Further, at the state public health level, as indicated in the recent Public Health Workforce Interests and Needs Survey (PH WINS), an estimated 25% of employees are planning to retire before 2020 with an additional 18% intending to leave their organizations within one year. Due to these workforce changes, there is an urgent need for public health organizations to examine how they are ensuring a talent pool from which leaders can emerge. As a large federal public health agency, the Centers for Disease Control and Prevention (CDC) faces the challenge of providing leadership development to staff. Factors were examined that agency leaders identified as key components of a leadership development program to transition scientific public health staff into supervisory leadership roles. While many factors contribute to leadership development, participants more often identified training, provision of opportunities, mentors, and identification of high potential employees as key components of a leadership develop program. With the need to develop organizational leaders to be ready when vacancies become available, findings from this study can inform the development and implementation of public health leadership development programs.