Amanda Dennis Dissertation Defense, June 18.
The Doctor of Public Health Program at the Boston University School of Public Health is pleased to announce the following doctoral dissertation defense: DrPH/SB Candidate: Amanda Dennis, MBE
Identifying and Responding to the Reproductive Decision-Making Needs of Women with Epilepsy
Dissertation Committee:
- Judith Bernstein, RNC, MSN, PhD (chair) (CHS)
- Deborah Bowen, PhD (CHS)
- Leonard Glantz, JD (HL)
- Kelly Blanchard, MS (President, Ibis Reproductive Health)
Monday, June 18 at 10:00 a.m.
Crosstown Center, 801 Mass. Avenue, Room #305
This event is open to the public. For more information, please contact Sebastian T. Bach, Doctoral Education Program Manager at (617) 638-4873 or drph@bu.edu.
ABSTRACT
Identifying and Responding to the Reproductive Decision-Making Needs of Women with Epilepsy
Background: Epilepsy is the most common neurological disorder in U.S. women of reproductive age. For women with the disorder, decisions related to having children, managing health during pregnancy, or utilizing contraception are central to neurological and reproductive health because some epilepsy treatments reduce the efficacy of hormonal contraceptives and increase the risk of malformations in offspring. Additionally, hormonal changes due to pregnancy or contraceptive use can influence seizure activity.
Methods: This dissertation aimed to illuminate the reproductive decision-making processes and needs of women with epilepsy through a framework analysis of one year of reproductive-focused postings to online forums for women with epilepsy and 30 in-depth interviews with women with epilepsy of reproductive age.
Findings: Women’s reports showed that their abilities to make and implement informed reproductive decisions depend upon financial and emotional resources, as well as on women’s capacities to clarify values surrounding reproductive and neurological outcomes, navigate a segmented health care system, and weather stigma. Overall, women described feeling knowledgeable and prepared to make and implement decisions about having children and managing their health throughout pregnancy while encountering considerable challenges with contraceptive decisions. In the worst cases, these challenges led to unplanned pregnancies, increased seizure occurrence, regretted sterilizations, and lack of trust in clinical providers.
Intervention: Findings were used to develop a decision aid designed to support women in making informed contraceptive decisions. This aid includes information about epilepsy and contraception, stories of women’s experiences with contraception, a values clarification exercise, and methods for facilitating discussions of contraceptive needs with clinical providers. In a pre-post evaluation with 14 women with epilepsy, the decision aid was found to be acceptable and effective at increasing knowledge, values clarity, and self-efficacy.
Conclusions: This dissertation fills gaps in awareness about contraceptive needs of women with epilepsy and moves public health practice forward. The developed decision aid is a resource that educates women with epilepsy about specific contraceptive options, helps them explore values, and guides them in implementing informed contraceptive decisions. It can serve as a model for developing similar tools for women with other health conditions requiring medication during the reproductive years.