Young women ages 16-29 years utilizing family planning (FP) clinics report significantly higher rates of intimate partner violence (IPV) compared to general population prevalence estimates, experiences which are associated with poor reproductive health outcomes, particularly unintended pregnancy. In the parent study from which this study emerges (Miller, R01HD064407), 46% of females seeking FP services report ever experiencing IPV. One mechanism connecting IPV with poor reproductive health is male partners'control of women's reproduction through their refusal to use condoms, abusive responses to women's use of contraception, pressuring women to get pregnant, and birth control sabotage;cumulatively, these partner behaviors constitute a phenomenon described as reproductive coercion (RC). Five percent of clients in the parent study report experiencing RC in the past 3 months which is closely associated with increased rates of unintended pregnancy in the past year. Thus, addressing IPV/RC in the FP clinic setting has the potential to reach significant numbers of women at risk for violence victimization and unintended pregnancy. The proposed exploratory study uses a two-armed cluster-randomized design to test a communication skills-building approach to improve IPV/RC assessment in the FP setting. The parent study is a randomized trial testing a brief, universal IPV/RC assessment and harm reduction intervention. Two thirds of participants report discussing IPV with their clinician (69%) and even fewer (23%) discussed RC with their provider. Focusing on provider communication-skills has been shown to increase provider self-efficacy when discussing other sensitive topics. Thus, adding communication skills training to providers'training on IPV/RC may improve the frequency and quality of IPV/RC assessment and counseling in the FP clinic setting. While prior IPV/RC trainings (including those provided in the parent study) have focused on increasing provider knowledge, this proposed training also incorporates communication skills-building and uses audio recorded client-provider discussions to examine the frequency and quality of IPV/RC assessment and counseling. This R03 expands the impact of the original parent study by incorporating and evaluating the influence of communication skills- training on FP providers'assessment and counseling regarding IPV/RC with the goal of increasing women's safety and improving reproductive decision making. Audio-recorded client-provider discussions will be used to assess whether a communication skills-based training improves the frequency and quality of FP providers'assessment and counseling regarding IPV/RC (Aim 1, 4 clinics;N = 100 clients). Interviews with clients (n = 40) and providers to review the audio-recorded visits will explore attitudes, concerns, and experiences discussing IPV/RC and impact on reproductive decision making. This exploratory study to identify strategies to enhance provider skills in IPV/RC assessment and counseling will inform quality improvement in intervention delivery as well as guide implementation and dissemination planning of this intervention model.
Addressing intimate partner violence (IPV) and reproductive coercion (RC) with female clients in the family planning clinic setting has the potential to reach significant numbers of women at risk for violence victimization and unintended pregnancy. The proposed exploratory study uses a two-armed cluster-randomized design to test a communication skills-building approach to improve IPV/RC assessment and counseling in the family planning setting. Identifying strategies to enhance family planning provider skills in addressing IPV/RC will inform quality improvement in intervention delivery as well as guide implementation and dissemination planning of this intervention model.