Family Planning in Appalachia: Focus Group Interviews with Stakeholders in the Context of the Opioid Epidemic

Background and Purpose: Even though Appalachian women face challenges related to accessing health services, the reproductive health needs of women in Appalachia remain understudied. The purpose of this presentation is to report findings from a focus group study of Appalachian stakeholders who were asked to identify information about the region’s unmet family planning needs in the context of the opioid epidemic, in order to inform the development of quantitative survey questions.

Methods: This qualitative study was funded through a Society of Family Planning Innovations research grant. Three focus group interviews were conducted remotely, via the Zoom video call platform, with community stakeholders in the Appalachian region (N=16), who were recruited using purposive sampling. All participants were Appalachian residents employed in service-oriented sectors, including healthcare organizations and university settings. Participants were compensated for their time with $50 retail gift cards. The interviews were guided with structured questions designed to elicit information about respondent’s perspectives around family planning needs and the opioid epidemic, in order to generate information to design questions for the development of a culturally-appropriate, quantitative measurement tool. Focus groups were recorded and then professionally transcribed. Data were analyzed to identify pre-determined themes in the five areas of healthcare access laid out by Levesque, Harris, and Russell (2013), using the principles of Braun and Clark’s (2012) approach to thematic analysis.

Results: Responses from the interviews were categorized into the following five overarching categories that represent the aspects of healthcare access conceptualized by Levesque, Harris and Russell (2013): (1) approachability (the ability to perceive the need for care), (2) acceptability (the ability to seek care), (3) availability and accommodation (the ability to reach services), (4) affordability (the ability to pay for services), and (5) appropriateness (the ability to engage in services). Subthemes were also identified within each of the five overarching categories. Issues related to approachability included sexual and reproductive health information, knowledge about health services, and trust in healthcare providers. Barriers to acceptability were social norms and values, including fear of judgment and fear of legal repercussions, that prevented patients from seeking reproductive healthcare. Issues related to availability and accommodation included difficulties accessing care because of transportation, location of services, limited appointment availability, and limited services offered to pregnant women who use substances. Affordability barriers included difficulties paying for care because of the cost of services and a lack of health insurance. Finally, issues related to appropriateness included difficulties with adequate provider training and provider bias in service delivery.

Conclusions and Implications: These results highlight the stakeholders’ perceptions that there is not enough existing knowledge about how women in Appalachia navigate unmet family planning needs in all five of the above aspects of healthcare access. These focus group results will inform our future work, as we are incorporating these concerns into the design of an instrument that will more broadly examine the unmet family planning needs of Appalachian women in the context of the opioid epidemic in the region, in order to eventually inform the design of culturally-relevant interventions.