The rate of adolescent unintended pregnancy in the United States is high compared to other developed countries. While past research and interventions have largely focused on young women, the role of young men in pregnancy prevention has increasingly been recognized. Studies have assessed young men’s knowledge and attitudes toward pregnancy prevention as well as their role in male-controlled methods of birth control like condoms or withdrawal. However, less is known about how young men can contribute to or participate in decision-making with female partners about contraception other than condoms. The purpose of this systematic review was to explore how young men communicate with their partners and its impact on contraception use to prevent pregnancy. A systematic review of five databases was conducted to identify English-language articles published from January 1, 2002, through July 7, 2018. The review specifically explored how male partner communication affects female partner use of contraception other than condoms among young men ages 11-24 years. The systematic review explored additional questions, including those pertaining to the timing of partner communication in a relationship, strategies employed by young men, and which dynamics of partner communication are measured in studies. Of the 15 articles identified as exploring areas of communication, five of the articles used quantitative analysis to measure any association between partner communication and contraception use, and three of those produced statistically significant findings suggesting that communication increases the use of contraception other than condoms. Three qualitative studies provided supporting narratives of how young men have communicated with partners and influenced their contraception use with female partners. The remaining seven articles explored the other research questions of timing, strategies, and dynamics identifying topics, prompts, and communication cues among young men. Measurements of both communication and contraception varied across studies. With the small number of studies identified in this systematic review, it is recommended that future research seek to corroborate the relationship between partner communication and contraception use with more robust and precise measurements of both communication and contraception.

This dissertation describes the patient experience. In Chapter One, we review the currentstate of patient-centered care with a specific focus on women’s experiences in infertility treatments, highlighting the gaps in our understanding of their experiences. The four independent but complementary aims of the dissertation studies are then introduced, and we identify how they address current gaps to advance our understanding of women’s experiences using reproductive technology. In Chapter One, we also introduce an innovative service design tool, journey mapping, as well as the Burden of Treatment Framework which guided the dissertation. Chapter Two, An Integrative Review of Journey Mapping to Document the Patient Experience, presents an integrative review examining the use of journey mapping in health care services research. In the analysis of these twenty-two studies, we demonstrate how journey mapping has been adapted to describe the patient experience. While the qualitative rigor of the included studies is of good quality, the inconsistent application of design standards in the accompanying visualizations, when present, suggests that further work and guidance is needed in the adaptation of this service design tool for the health research field. In Chapter Three, Journey Mapping the Patient Experience of IVF: A Social Media Analysis, we used posts from the largest infertility subreddit and patient-facing online resources to describe and visually depict the patient experience of IVF in two journey maps representing the experiences of women in their first cycle of infertility treatment and women in repeat cycles. Findings highlighted problems and unmet needs in the infertility treatment experience, including information needs, communication needs, and support needs. Chapter Four, The Burden of Treatment in IVF: An Analysis of Social Media Using a Framework for Chronic Complex Conditions, used qualitative descriptive methodology to guide inductive and deductive content analysis of posts from the same infertility subreddit. Findings suggest that Eton’s framework is applicable to infertility, but can be expanded by the inclusion of three new constructs that we identified. Finally, Chapter Five synthesizes the key findings across these four aims, outlining their strengths and limitations, and discussing implications for future research, policy, and clinical practice.

The aim of this study is to explore the introduction of IsiXhosa (iintsomi) as an alternative method in the maternal health education in rural Primary Health Care in the Eastern Cape. An informal preliminary observation of a maternal health lesson by the researcher indicated a further need for maternal health educators to introduce storytelling into the health content themes. To re-inforce the maternal health educator lesson on the causes of teenage pregnancy, lifestyles for pregnant women, causes of miscarriage and termination of pregnancy, the Community Health Workers can undoubtedly use isiXhosa iintsomi in selected clinics and maternal waiting homes. As a readily available resource that cuts across all literacy barriers, iintsomi (isiXhosa) fosters a cross-cultural consultation which enables the healthcare worker to convey messages that make sense to the rural women. While the conventional methods of teaching have a tendency to create tension and lack of participation, use of folktale (iintsomi) have huge potential to bring lesson enjoyment; a meaningful interaction and story sharing by the maternal health educator, the pregnant women and greater community; access to important health messages; and strengthened utilisation of Primary Health Care. The study therefore suggests that there is a place for isiXhosa iintsomi: From the Fireplace into the Workplace.