CARE Women's Health publishes in AJPH

Drs. Michael Smith, Nathan Hale, Kate Beatty, and Amal Khoury, faculty in East Tennessee State University College of Public Health’s Center for Applied Research and Evaluation in Women’s Health have published an article in the American Journal of Public Health.  The article, South Carolina’s Choose Well Initiative to Reduce Unintended Pregnancy: Rationale, Implementation Design, and Evaluation Methodology, describes the implementation and evaluation of the Choose Well, a contraceptive access initiative in South Carolina. The article appears in a special issue of the American Journal of Public Health that is devoted to discussing the strengths, limitations, benefits, and opportunities for statewide contraceptive access initiatives in the US.

Choose Well, led by the nonprofit organization New Morning, was a six-year statewide contraceptive access initiative that operated in South Carolina from 2017-2022. Choose Well’s model was based on collective impact principles and engaged over 100 clinical partners from all 46 counties in South Carolina to try to expand access to contraception. Choose Well provided funding and training to clinics to promote access to contraception without judgement or coercion and implemented a statewide multimedia campaign to let residents of the state know about the available services. Though the original funding for Choose Well sunset at the end of 2022, Choose Well is continuing key components of the initiative into 2023 with more sustainable funding. Sarah Kelley and Katherine Satterfield, staff at New Morning in Columbia, South Carolina, are co-authors of the article.

The Center for Applied Research and Evaluation in Women’s Health in the College of Public Health at ETSU is leading the evaluation of Choose Well. The evaluation is based on the RE-AIM evaluation framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) which is applied through a behavioral model of health service use to operationalize a rigorous series of studies assessing the effectiveness of Choose Well. These evaluation studies use a variety of methodologies and data sources including using extensive data collected by ETSU researchers to advance the evidence around the implementation processes, effectiveness, and sustainability of statewide contraceptive access initiatives.

Unlike most articles that are data-driven, this piece is focused on implementation and evaluation science in public health interventions and helps inform the field on novel and systematic ways of doing this significant work.  “It is exciting that AJPH has published a special issue devoted to contraceptive access initiatives. The interest in the scientific and policy communities around these initiatives underscores their importance for advancing access to reproductive health services, primarily for low-income and other underserved populations. Today, more than ever, there is need for rigorous evaluation studies that build the evidence around the effectiveness of state-wide initiatives and their role in reducing health care disparities and promoting contraceptive equity,” said Dr. Amal Khoury, Director of the Center for Applied Research and Evaluation in Women’s Health.  

The evaluation is well positioned to assess key outputs and impacts associated with Choose Well and to contribute to the evidence base for statewide contraceptive access initiatives. “These are important issues not just in the southeast, but across the nation as health care providers and health systems try to find the right balance between evidence-based care and coercion. Their patients should have access to the full range of contraceptive options approved by the Food and Drug Administration (FDA), but they should not be pressured to use a contraceptive method that they don’t think is best for them. Having thorough, independent evaluations is an important way to help ensure that we know what works and does not work when we try to get this balance right,” said Dr. Michael Smith, Program and Policy Director for the Center for Applied Research and Evaluation in Women’s Health.