Mixed-methods outcomes from a statewide contraceptive access initiative in Missouri: How The Right Time supports access, method availability and patient-centered care

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OBJECTIVES: The Right Time (TRT) is a statewide contraceptive access initiative with a three-pronged approach (supply, demand, and environment) to improve access to information and contraceptive services in Missouri. We evaluated TRT's supply prong focused on access, method availability, use of methods, and patient-centered care. STUDY DESIGN: We used a mixed-methods descriptive design at participating TRT health centers that included health center surveys (n = 12), patient clinical encounter data (n = 69,969), patient experience surveys (n = 131) and focus groups (n = 56). RESULTS: There was an increase in the number of contraceptive methods health centers had in stock and could offer the same day between baseline and 18 months. There was a 5.5% point (pp.) increase in TRT patients' use of any contraceptive method between intake and exit. There was an increase in use of pills (+8.5 pp.), injections (+3.6 pp.), and intrauterine devices (+3.3 pp.) and a decrease in use of condoms (-9.9 pp.) and other non-hormonal methods (+2.8 pp.). In all, 82% of patients rated their provider as "excellent," and focus group participants reported patient-centered experiences with providers and few access barriers. CONCLUSIONS: Findings suggest TRT's supply prong may be improving access to contraception and contributing to uptake of contraception in the context of patient-centered care. Our mixed-methods approach illustrates how contraceptive access enables patient-centered care and contributes to the literature on statewide contraceptive access initiatives.

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