October 2, 2012
By Steve Tokar
Although it's proven that contraception prevents pregnancy, it's also clear that many women who don't want to get pregnant don't use or don't have access to contraception.
"There is an implementation failure here. We have evidence, and it's not being utilized," said Christine Dehlendorf, MD, MAS (right), a family physician based at San Francisco General Hospital and Trauma Center, and an assistant professor in residence of family and community medicine at the UCSF School of Medicine.
Through a desire to help women navigate decisions about contraception, Dehlendorf became familiar with implementation science (ImS), which is focused on improving health by translating clinical findings into real-world interventions.
An experienced clinician, Dehlendorf knows that the issues surrounding reproductive decisions are complex, and that contraceptive counseling discussions are intimate and challenging to begin with. "Providers are trying to do this within a medical system that allows very limited time during a clinic visit for any kind of discussion about preventive health," she said. "Even if providers know the right thing and would like to do it, they aren't always able to."
Dehlendorf's observations conform to a basic tenet of implementation science, said Sara Ackerman, PhD, MPH, a medical anthropologist and program coordinator with the Implementation Science program managed by UCSF's Clinical and Translational Science Institute (CTSI). "There is increasing awareness that the approach of 'give people knowledge and they'll do the right thing' does not usually bring about a desired change in behavior," Ackerman said. "Implementation science acknowledges that context always matters, and that behavior is situated within a complex web of influences, many of which we are not in control of or even aware of."