Individual Interview Guide - Staff English

Attachment K-3. Semi-structured interview guide for Z-CAN clinic staff (English)

INTRODUCTION

Hello. My name is (insert name). I am representing Total Solutions, Inc., an independent organization that is gathering information about the Zika Contraception Access Network (Z- CAN).

Welcome and thank you for agreeing to participate in this interview. Your experience and opinions are very important to us. Your participation in this interview will help us understand your experience as a staff person at a clinic in the Zika Contraception Access Network (Z- CAN).

We are especially interested in learning about your perceptions regarding:

• barriers to providing contraceptive services,

• the implementation of the Z-CAN program,

• the reimbursement process for Z-CAN services provided, and

• how to continue to improve access to contraceptives for women in Puerto Rico.

As part of our protocol, all interviews are recorded so that we can fully capture your opinions. However, everything you say will be kept completely private, and your name or the name of others will not be used in reporting the findings of the study. The tape will be stored safely in a locked facility until it is transcribed, after which it will be destroyed. The interview will take no more than an hour and is completely voluntarily. You can choose to stop or skip any questions you feel uncomfortable answering. We realize you are very busy and we appreciate your time.

Before we begin, do you have any questions for me?

Introductory questions

First, I would like to ask you about your position at the clinic in which work and your experiences working there.

• What is your role or position at the clinic?

Probe: What are your daily tasks?

• How would you describe your clinic?

Probe: Private practice/community health center, large/small, rural/urban?

• How would you describe the women of reproductive age that you serve in your clinic?

Probe: Demographics? Type of services they seek? Insurance status?

• Before the Z-CAN program, did you conduct or perform contraceptive counseling as part of your daily activities on staff at the clinic?

If yes, Probe:

• How did you counsel women?

• Did you counsel women before they met with their provider? How did it work in your clinic?

• How did this process work in your clinic?

Patient-centered contraceptive counseling

MODERATOR: Now, I would like to ask you a few questions about contraceptive counseling. Please take a few minutes to think about your experience performing contraceptive counseling and how these services are delivered in your clinic among women of reproductive age during the Z-CAN program.

• What does patient-centered contraceptive counseling mean to you?

Probe: What are some of the key features of patient-centered contraceptive counseling?

• What are your thoughts on performing patient-centered contraceptive counseling in your practice?

Probes:

• Who provides the majority of counseling? You or the physician(s) in your clinic or someone else?

• How do you feel about offering this counseling?

• Has the Z-CAN program training changed how you provide contraceptive counseling to women in your clinic?

Probe: Why or why not? How is it different?

• Please explain how your clinic supports patient-centered contraceptive counseling?

Probes:

• Have the other clinic staff been supportive of providing patient-centered contraceptive counseling?

• Are the physicians in your clinic supportive of providing patient-centered contraceptive counseling?

• What type of support do you receive?

• What are the challenges with performing patient-centered contraceptive counseling in your clinic?

Probe: Do you have enough time in your schedule?

• Will you continue to provide patient-centered contraceptive counseling after or outside the Z-CAN program?

Probe: Why or why not?

Perceptions of barriers of contraception access among women of reproductive age

MODERATOR: Thank you. Now, I would like to ask you a few questions on the topic of access to reversible contraceptive methods. We would like to learn about any factors that act as a barriers to reversible contraception access for women of reproductive age in Puerto Rico.

• Why do women in Puerto Rico not seek out or utilize reversible contraceptive services?

Probes:

• Awareness/knowledge about contraception?

• Beliefs/attitudes towards contraception?

• Cultural issues?

• Religious issues?

• Support/lack of support of partner/spouse, family, friends?

• Thinking back to before the Z-CAN program, what challenges did women of reproductive age encounter when seeking reversible contraception?

Probes:

• Access to appointments?

• Access to patient-centered contraceptive counseling?

• Access to long-acting reversible contraception, such as IUDs and implants?

• Insurance coverage/cost of different types of birth control?

• With the Z-CAN program, what are some challenges to reversible contraception access that women of reproductive age in Puerto Rico still experience? Are there any new challenges?

Probes:

• Access to appointments?

• Access to patient-centered contraceptive counseling?

• Access to long-acting reversible contraception, such as IUDs and implants?

• Insurance coverage/cost of methods?

• In counseling, are you concerned that women are being pressured to choose a particular contraceptive method?

Probe: Why or why not? In what way?

Knowledge, attitudes, and practices related to reversible contraception

MODERATOR: Now, I am going to ask you some questions about reversible contraception methods.

• How would you describe the availability of long-acting reversible methods, such as IUDs and implants, in Puerto Rico overall and in your clinic before the Z-CAN program?

Probes:

• How would you describe the availability of IUDs available to women in your clinic before the Z-CAN program?

• How would you describe the availability of implants available to women in your clinic before the Z-CAN program?

• How would you describe the availability of other reversible methods in Puerto Rico overall and in your clinic before the Z-CAN program?

Probes: pills? patch? ring? injections? condoms?

Implementation of Z-CAN program

MODERATOR: Thank you for your thoughts. Now, I would like to ask you a few questions about the Z-CAN program. We would like to understand your perceptions and your satisfaction with how the program has been implemented in your clinic.

• What aspects of the Z-CAN program do you think have had the most influence on your ability to provide quality patient-centered contraceptive counseling?

Probe: How so? In what ways?

• How would you describe the impact, if any, Z-CAN has had on addressing barriers to access to contraceptive services for women seeking services at your clinic?

Probes:

• What barriers in access have been addressed by Z-CAN in your clinic?

• What barriers in access remain?

• How would you describe the impact, if any, the Z-CAN program has had on contraceptive use among women seeking services at your clinic?

• How would you describe the impact of access to contraceptive services for the women in your community?

• Describe some of the challenges that you have encountered during the implementation of the Z-CAN program.

Probe:

• Changes to clinic flow, staffing, Z-CAN procedures, etc.

• What strategies have you used to overcome these issues?

• To what extent are you satisfied with how the Z-CAN program has been implemented in your clinic?

Probe: What can be improved?

• To what extent are you satisfied with Z-CAN training you received?

Probe: What can be improved?

• To what extent are you satisfied with responsiveness of the Z-CAN program staff?

Probe: What can be improved?

• How have you been involved with the reimbursement of services or ordering of contraceptive methods at your clinic?

Reimbursement and Supply Processes

MODERATOR: We are interested in getting some input on the administrative aspects of the Z-CAN program.

• Have you been involved in or worked with the reimbursement or supply process for contraceptive services in your clinic?

[MODERATOR: If the interviewee says YES, continue; If NO, then skip this section.]

• What do you think about the Z-CAN reimbursement process? How well is it working for your clinic?

Probes:

• Is reimbursement easy or difficult? Why or why not?

• What are the challenges?

• What was the time interval like between service delivery and receipt of reimbursement?

Probe: How long did it usually take to receive reimbursement for service delivery?

• Has the Z-CAN program provided your clinic with all contraceptive methods on a continual basis?

Probes:

• Does your clinic run out of product?

• What products does your clinic run out of?

• Do you feel like the re-ordering and resupply process is working well?

Zika virus

MODERATOR: Now I would like to ask you a few questions about how the Zika virus has impacted your clinic.

• Do many women express concern about Zika when seeking reversible contraception services?

• What advice are you providing women to protect themselves from Zika infection?

Program Recommendations and Sustainability

MODERATOR: We have come to the last series of questions of the interview. Thank you for everything you have shared thus far. I would like to ask you some questions about how expanded access to contraceptives in Puerto Rico can be sustained.

• How does your clinic plan to continue providing patient-centered contraceptive counseling for women of reproductive age after the Z-CAN program ends?

Probe: What is needed to ensure the sustainability of these efforts?

• How does your clinic plan to continue providing same-day access to the full range of reversible contraceptive methods for women of reproductive age after the Z-CAN program ends?

Probes:

• What is needed to ensure the sustainability of these efforts?

• Will efforts need to be different for IUDs and implants than for other reversible methods?

• What do you think are the long-term implications of being a Z-CAN provider? Positive or negative implications?

• How can the Z-CAN program be replicated in other clinics in Puerto Rico?

• Are you concerned that you are providing too many contraceptive services to the exclusion of other services you may provide at your clinic?

• Do you have any other thoughts or comments you would like to share? Is there anything else?

Closing. Thank you for your time.

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