Elsevier

Women's Health Issues

Volume 24, Issue 6, November–December 2014, Pages 594-599
Women's Health Issues

Original article
Women Know Best—Findings from a Thematic Analysis of 5,214 Surveys of Abortion Care Experience

https://doi.org/10.1016/j.whi.2014.07.001Get rights and content

Abstract

Objective

Patient experience is an essential component of quality care. Few studies have comprehensively evaluated patient experiences of abortion care. The objectives of this study were to describe women's experiences of abortion care in their own words, and to determine themes across patient experiences.

Study Design

Data for this thematic analysis, a qualitative method that allows for the identification, analysis, and report of patterns or themes within data, come from a larger study of safety and quality of aspiration abortion care across 22 clinical sites. Participants completed an abortion experience survey including fixed choice questions and an open-ended question: “Is there anything you would like to tell us about your experience?” The data were then categorized by responses to another survey question: “Overall, was your experience about, better, or worse than you expected?”

Results

A total of 5,214 responses were analyzed. Women reported positive abortion care experiences with the majority of women rating their experience as better than expected (n = 3,600). Two major themes that emerged from the data include clinic- and patient-level factors that impact how patients rate their experiences. Analysis of the responses categorized in the worse than expected group (n = 136) found that women primarily faulted clinic-level factors for their negative experiences, such as pain control and management, and wait time for appointments and in clinic.

Conclusion

This analysis highlights specific areas of abortion care that influence patients' experience. The few women who were disappointed by care in the clinic tended to fault readily modifiable clinical factors, and provided suggested areas of improvement to enhance positive experiences related to their abortion care.

Section snippets

Methods

Institutional review board approvals were obtained from the University of California, San Francisco; Ethical and Independent Review Services for Planned Parenthood clinics; and Kaiser Permanente of Northern California. Briefly, women at least 16 years of age (18 years at Planned Parenthood sites) seeking a first-trimester aspiration abortion (i.e., facilities self-defined this as ≤12 or ≤14 weeks' gestation by ultrasound) and who could read English or Spanish were recruited from 22 clinics

Results

Of the 9,087 women who completed the patient experience survey in the larger study, 5,255 women responded to the open-ended question. After exclusion for responses that were not at least a phrase or sentence in English, 5,214 usable narrative responses remained (57% of women completing the fixed-choice survey questions). Respondents (to the open-ended question) were on average 25 years old and the majority was non-Hispanic White or Hispanic, and had completed a high school degree or had some

Discussion

Echoing the very positive patient experience scores as reported from the larger study (Taylor, 2013), this analysis shows that most women found outpatient first trimester abortion care to be about what or better than they expected. Women's experiences described in the open-ended question expand our understanding of what women value in abortion care and how services can be improved. The five themes identified from the women's written comments (shame and/or stigma, staff treatment, clinical

Conclusions

Women reported very positive abortion care experiences; almost 70% rated their experience as better than expected. Very few rated their abortion experience as worse than expected (<4%). This qualitative analysis highlights specific areas of abortion care that influence patient experience outcomes and specific areas of clinical improvement that impact patient experience outcomes related to quality care and offer patient-suggested solutions. The few women who were disappointed by care in the

Acknowledgments

The study is grateful for the work of Tracy Weitz PhD, MPA, and the partner organization Principal Investigators: Jeff Waldman, MD; Mary Gatter, MD; Kate Sheehan, MD; Dick Fisher, MD; Debbie Postlethwaite, NP, MPH; and Amanda Calhoun, MD. Additional gratitude is extended to acknowledge the women who participated in this study.

Monica R. McLemore, PhD, MPH, RN, is an Assistant Professor in the Family Health Care Nursing Department and a Research Scientist at Advancing New Standards in Reproductive Health, both at the University of California, San Francisco.

References (21)

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Monica R. McLemore, PhD, MPH, RN, is an Assistant Professor in the Family Health Care Nursing Department and a Research Scientist at Advancing New Standards in Reproductive Health, both at the University of California, San Francisco.

Sheila Desai, MPH, was the Research and Evaluation Manager for the Health Workforce Pilot Project at Advancing New Standards in Reproductive Health, University of California, San Francisco.

Lori Freedman, PhD, is an Assistant Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences and a Medical Sociologist at Advancing New Standards in Reproductive Health, both at the University of California, San Francisco.

Evelyn Angel James, CNM, WHNP-BC, is a doctoral candidate in the Community Health Systems Nursing Department and a Research Resident at Advancing New Standards in Reproductive Health, both at the University of California, San Francisco.

Diana Taylor, PhD, RNP, MS, FAAN, is Professor Emerita in the Family Health Care Nursing Department and Director of Research and Evaluation of the Primary Care Initiative at Advancing New Standards in Reproductive Health, both at the University of California, San Francisco.

Funding and Conflict of Interest: Funding for this study was provided by grants from private foundations including the John Merck Foundation (A10943), the Educational Foundation of America (04038243), the David & Lucile Packard Foundation (A109955), and the Susan Thompson Buffet Foundation (A107143). In addition, the research was conducted under a legal waiver from the California Health Workforce Pilot Project Program, a division of the Office of Statewide Health Planning and Development. The authors report no conflicts of interest.

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