Methods
On this page:
- Recommendations Development Process
- Audience
- Equity Approach
- Incorporating Lived Experience
- Literature Reviews
- Orientation and Organization of the Recommendations
Recommendations Development Process
OPA developed these recommendations in consultation with a wide array of experts and partners. OPA hired a contractor to convene an Expert Workgroup (EWG) comprising experts in the fields of SRH and health equity who had relevant professional and lived experience representing a broad range of sectors and communities. The EWG and OPA identified research gaps in a series of systematic literature reviews and environmental scans. The contractor then assembled technical expert panels (TEPs) of subject matter experts for each of the topics. The TEPs reviewed the results of the literature reviews and the quality of the evidence and provided feedback on recommendations supported by a rigorous review of the evidence and the use of established equity principles (see Exhibit 2).
Drawing from established procedures for developing clinical guidelines and recommendations, including the National Academies of Sciences, Engineering and Medicine (NASEM) (formerly IOM) standards,5 OPA adapted a multistage process in crafting this QFP update. The recommendations were drawn from an extensive literature review; individual feedback from subject matter experts, including persons with lived experience and members of the EWG and the TEPs; and a group of external reviewers (See List of Contributors).
Federal agencies and relevant professional organizations were consulted for updated clinical practice guidelines and recommendations. Guidelines, recommendations, statements, and committee opinions from the following organizations are included in this QFP update: Centers for Disease Control and Prevention (CDC), United States Preventive Services Task Force (USPSTF), the Health Resource and Services Administration (HRSA), Women’s Preventive Services Initiative (WSPI), American Academy of Pediatrics (AAP), American Society for Colposcopy and Cervical Pathology (ASCCP), American College of Obstetrics and Gynecology (ACOG), American Society of Reproductive Medicine (ASRM), American Urological Association (AUA), Society of Family Planning (SFP), American Cancer Society (ACS), National Comprehensive Cancer Network, World Sexual Health Association, Center for Excellence for Transgender Health, and World Professional Association for Transgender Health (WPATH).
In instances where the guidance or related materials of other organizations are described, specific organizational affiliations are included. The systematic literature reviews and other evidence used to prepare these recommendations are published in the American Journal of Preventive Medicine.23, 24, 25, 26 OPA funded all work contributing to this update.
Audience
The primary audience for this update is clinical providers and potential providers of SRH services to people of reproductive age. They include clinicians, educators, community health workers, and other licensed and non-licensed health care providers. These recommendations are addressed to providers working in service sites dedicated to SRH service delivery, including Title X-funded clinics and federally qualified health clinics (FQHCs), as well as primary care providers, specialists, and other providers who may identify SRH needs and make referrals. Medical directors and others responsible for developing clinical protocols may also use the QFP recommendations to support policy and protocol development.
Equity Approach
Acknowledging the importance of incorporating equity throughout SRH services, OPA engaged with the HHS Equity Technical Assistance Center (ETAC) in 2022 to conduct an equity-focused review of the QFP update and recommendations.
The approach sought to reflect QFP’s role in supporting SRH care provision that is person-centered, inclusive, equitable, and accessible to ensure high-quality care for all and facilitate dissemination and implementation. A set of equity tools was developed and used throughout the process to ensure a commitment to the stated goal of advancing SRHE.26 These tools were integrated into the review process to ensure all updates and changes were considered through an equity lens and served the larger mission of integrating equity in SRH services. The overarching equity principles were developed to guide all activities involved in the QFP update process and serve as a foundation for QFP recommendations’ equity focus. Specific to the systematic literature reviews, the review team drew from an adapted version of the PRISMA Extension for Equity Review Checklist, as opposed to the standard PRISMA checklist, to confirm equity was appropriately considered throughout the evidence.27 Together, these tools were used to ensure that equity remained the focus of all recommendations at each step in the process.
Incorporating Lived Experience
OPA engaged with people with diverse lived experiences to ensure that recommendations were informed by various perspectives in addition to the published evidence. The following approaches were used:
- Formation of EWG and TEPs to ensure inclusion of persons representative of the diversity of racial, ethnic, disability, sex, sexual orientation and gender identities across the United States, as well as multidisciplinary academic and professional experience, including researchers, clinical providers, and patient advocates (see roster in Appendix 5).
- Listening sessions with FP clinical providers and administrators: Advised OPA on an individual basis on the content and usability of the original QFP report, discussed proposed updates to the QFP recommendations and opportunities to improve the QFP update’s inclusivity and functionality.
- Visioning sessions with Title X providers: Discussed strategies for making the QFP recommendations user-friendly and adaptable.
- Lived experience panels (LEPs) with users of SRH services: Provided individual feedback on proposed changes to QFP and related research, potential impact of those changes, and the extent to which the evidence reflected their preferences and lived experiences.
Literature Reviews
OPA commissioned a set of systematic literature reviews on the following topics: Contraceptive Counseling, Education, and Care and Screening for the Need and Desire for SRH Care.23, 24, 25, 26 OPA also commissioned two environmental scans on Performance Measures to Improve the Quality of SRH Services and Guidelines for Core SRH and Adjacent Services (unpublished). Given existing clinical guidelines and recommendations, OPA determined that the largest gaps were related to contraceptive counseling and provision. This determination corresponded well with OPA’s core mandate to provide guidance to FP providers. A more detailed description of the methods used to conduct the literature reviews is provided in the accompanying journal supplement.23, 24, 25In addition, OPA commissioned a rapid systematic review of SRH Services Delivered via Telehealth.28
Orientation and Organization of the Recommendations
The QFP update is divided into 11 sections. The initial sections describe the context for this update and the methods used to develop the QFP recommendations. Subsequent sections describe the fundamentals of SRH care and how to assess an individual’s need and desire for SRH services, the provision of person-centered contraceptive care, STI and HIV screening and treatment, family building, pregnancy testing and counseling, early pregnancy management, screening and other preventive health care services, and how to use performance measures to track and improve the quality of SRH care.
To accompany this update, technical assistance (TA) resources will be available from OPA, the RHNTC, and the CTC-SRH to facilitate adoption of the QFP recommendations. These resources include this website, managed by the RHNTC—www.QFPguide.org.