Renal replacement Therapy and Barriers to choice: using a Mixed Methods approach to explore the Patient's Perspective.

Alternatives to in-center hemodialysis as treatment for end-stage renal disease have been shown to increase patient quality of life, decrease co-morbidities and decrease financial strain on both the patient and the health care system. Focus groups (n = 6 groups with 47 participants) and survey data (n = 113) were used to ascertain perceived barriers and facilitators to alternative therapies and psychosocial and educational issues that may affect a patients' choice of modality among patients utilizing in-center dialysis, home dialysis and renal transplantation. Fear emerged as a predominant theme, both at diagnosis and when choosing a modality. Distrust of the medical system, denial and patient experiences with previous modalities were seen as barriers to care. Results imply that interventions addressing fear and providing more comprehensive pre-dialysis education may decrease barriers.

Recruiting a diverse group of middle school girls into the trial of activity for adolescent girls.

BACKGROUND: School-based study recruitment efforts are both time consuming and challenging. This paper highlights the recruitment strategies employed by the national, multisite Trial of Activity for Adolescent Girls (TAAG), a study designed to measure the effectiveness of an intervention to reduce the decline of physical activity levels among middle school-aged girls. TAAG provided a unique opportunity to recruit large cohorts of randomly sampled girls within 36 diverse middle schools across the United States. METHODS: Key elements of the formative planning, coordination, and design of TAAG's recruitment efforts included flexibility, tailoring, and the use of incentives. Various barriers, including a natural disaster, political tension, and district regulations, were encountered throughout the recruitment process, but coordinated strategies and frequent communication between the 6 TAAG sites were helpful in tailoring the recruitment process at the 36 intervention and control schools. RESULTS: Progressively refined recruitment strategies and specific attention to the target audience of middle school girls resulted in overall study recruitment rates of 80%, 85%, and 89%, for the baseline, posttest, and follow-up period, respectively. DISCUSSION: The steady increase in recruitment rates over time is attributed to an emphasis on successful strategies and a willingness to modify less successful methods. Open and consistent communication, an increasingly coordinated recruitment strategy, interactive recruitment presentations, and participant incentives resulted in an effective recruitment campaign.

Validation of a job aid to rule out pregnancy among family planning clients in Nicaragua.

In Latin America, one of the most common barriers to family planning access is denial of services to women who present at clinics in the absence of menses. Where pregnancy tests are unavailable, many providers fear that nonmenstruating women may be pregnant and, worrying about possible harm to the fetus, require the woman to await the onset of menses before initiating a contraceptive method. In 2005, during a randomized trial of oral contraceptive users in Nicaragua, we assessed a job aid endorsed by the World Health Organization to help providers exclude pregnancy among family planning clients. Among 263 new, nonmenstruating clients, the job aid ruled out pregnancy for 60% of the women. Only 1% of the women were pregnant, and no woman identified by the job aid as "not pregnant" was pregnant. Provider fears that nonmenstruating clients are pregnant are usually misplaced, while fears that hormonal methods can harm fetuses are exaggerated.

Validation of a job aid to rule out pregnancy among family planning clients in Nicaragua

In Latin America, one of the most common barriers to family planning access is denial of services to women who present at clinics in the absence of menses. Where pregnancy tests are unavailable, many providers fear that nonmenstruating women may be pregnant and, worrying about possible harm to the fetus, require the woman to await the onset of menses before initiating a contraceptive method. In 2005, during a randomized trial of oral contraceptive users in Nicaragua, we assessed a job aid endorsed by the World Health Organization to help providers exclude pregnancy among family planning clients. Among 263 new, nonmenstruating clients, the job aid ruled out pregnancy for 60 percent of the women. Only 1 percent of the women were pregnant, and no woman identified by the job aid as "not pregnant" was pregnant. Provider fears that nonmenstruating clients are pregnant are usually misplaced, while fears that hormonal methods can harm fetuses are exaggerated.

En América Latina, uno de los obstáculos más frecuentes para acceder a los servicios de planificación familiar es la negativa a atender a las mujeres que se presentan en las clínicas sin menstruación. Cuando no hay pruebas de embarazo disponibles, muchos profesionales piensan que las mujeres sin menstruación visible pueden estar embarazadas y por temor a ocasionar algún daño al feto les exigen esperar hasta el inicio de la menstruación para comenzar con algún método anticonceptivo. En 2005, durante un ensayo aleatorizado con usuarias de anticonceptivos orales en Nicaragua, se evaluó una lista de verificación avalada por la Organización Mundial de la Salud para ayudar a los profesionales sanitarios a descartar el embarazo en las mujeres que solicitan servicios de planificación familiar. Este procedimiento permitió descartar el embarazo en 60 por ciento de las 263 mujeres sin menstruación que solicitaban por primera vez ese servicio. Solamente 1 por ciento de las mujeres estaban embarazadas y ninguna de las identificadas por este procedimiento como "no embarazada" lo estaba. El temor de los profesionales de la salud de que las mujeres sin menstruación estén embarazadas es frecuentemente infundado y los temores de que los métodos hormonales puedan dañar al feto son exagerados.