Women’s Voices: Exploring Context and Practical Strategies for Women’s Health Shared Decision-Making in Community Health Settings

Abstract

Shared decision-making (SDM) represents an opportunity to increase patient involvement in their healthcare. Limited research exists on the factors impacting women’s reproductive decision-making and what practical needs may be. This study aimed to identify factors women perceived as influencing their reproductive health decisions (e.g., family planning, accessing routine gynecological care) and to understand how these factors impact SDM within the reproductive healthcare context. We completed six focus groups with women aged 18 to 45 years in the United States. Women’s SDM processes were explored using techniques from grounded theory. This study offered insight into factors influencing women’s reproductive healthcare decisions and how these factors can negatively impact SDM. Participants indicated a desire to be invited into the healthcare discussion in which providers listened, supported, and validated their choices and needs. Participants provided recommendations from positive experiences to identify their preferences during a woman’s healthcare appointment. Additionally, participants described quality time as more important than the quantity of time spent during consultations. Prior negative healthcare experiences attributed to interaction with healthcare providers affected their SDM perspectives and healthcare engagement, as did family/friends and race. Participants suggested that previous interactions with healthcare providers influenced their decision to seek healthcare, explicitly citing community-based reproductive healthcare. Findings provide recommendations on how clinicians can engage in SDM, practical opportunities to fulfill women’s patient–provider involvement needs, and new insights into continuing to develop the SDM model in reproductive healthcare.

Keywords:

• Shared decision-making
• patient-centered care
• reproductive health
• qualitative methodology
• community-based healthcare

Acknowledgments

The authors would like to thank members of the Interdisciplinary Women’s Reproductive Health Collaborative at Purdue University who are not listed as coauthors for their continued support of the project. We would also like to acknowledge Natalie Murdock for her work on the project. Additionally, we thank Dr. Jaziel Ramos-Ortiz for her study support.

Ethical approval

The Purdue University Institutional Review Board approved the study.

Informed consent

All participants provided written informed consent to participate in the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Interview guide available on reasonable request.

Figure 1. Contextual factors identified in the Results represented with the Socio-ecological Model (CDC, 2022). Schematic showing women’s contextual factors at different levels of the socio-ecological model, which may impact reproductive healthcare decisions.

Additional information

Funding

This research was partially funded by the Purdue University Office of Engagement and the Purdue University Health and Human Sciences Undergraduate Research Honors Scholars Program. Additionally, the study was funded by Drs. Monica Kasting and Laura Schwab Reese in the Department of Public Health at Purdue University. Monica Kasting is supported by grant numbers KL2TR002530 (B. Tucker Edmonds, PI) and UL1TR002529 (S. Moe and S. Wiehe, co-PIs) from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award. The funding sources had no involvement in the study design, collection, analysis, and interpretation of data, in writing the report, and in the decision to submit the article for publication.