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Open Access Publications from the University of California

Scholarly Works (8 results)

  • Thesis
  • Peer Reviewed
UC Berkeley Electronic Theses and Dissertations (2024)

Abortion access in the United States has been in a state of rapid change and increasing restriction since the Dobbs v. Jackson Women’s Health Organization decision in June of 2022. Consequently, the months following the Dobbs leak and subsequent decision in 2022 presenting a uniquely uncertain and challenging time for abortion access. With further constraints on access since Dobbs, the internet and online communities are likely playing an increasingly important role in people’s abortion trajectories as a source of information, peer interaction, and health services—but there is limited knowledge about their use since the Dobbs leak. The “r/abortion” subreddit is a Reddit-based community that provides a unique environment for people to seek and share abortion-related support. Within Reddit’s pseudonymous structure, moderators of r/abortion create a safe environment for discussions of abortion by managing anti-abortion contributions and misinformation. With the Dobbs decision, pathways to abortion care, sources of social support, and challenges to access were in flux in ways that researchers are still seeking to understand. r/abortion, as an exemplary abortion-supportive online community, presents both a case study of the ways an online abortion community was used and a window into the abortion-related experiences of community members during this time. Accordingly, this research was designed to analyze data from r/abortion from 2022 using Natural Language Processing and thematic qualitative analysis in an explanatory parallel mixed-methods approach. In the first Chapter, “Using Natural Language Processing to describe use of r/abortion during 2022: Using a dynamic topic approach to analyze Reddit post data from an online community for abortion,” we describe the findings of a Natural Language Processing analysis of posts shared in r/abortion during 2022. We explore the content of posts and assess if use of the community changed during 2022 in relation to key change points in national policy. This analysis consisted of several key steps to describe and explore posts shared throughout the entire year and for three sub-periods of interest: pre-Dobbs-leak (12/24/2021-5/01/2022), Dobbs-leak to decision (5/02/2022-6/23/2022), and post-Dobbs-leak (6/24/2022-12/23/2022). In the 7,273 posts shared in r/abortion in 2022 included in our analyses, we found that people posted about a wide range of topics, including seeking pathways to access abortion, support during and after their abortion in managing the process, community input on pregnancy confirmation, input on assessing abortion completion and post-abortion experiences, and sharing on abortion decision-making. We also found that while posts increased overall following the Dobbs decision, the greatest increase was in posts related to self-managed abortion. While this analysis had limitations, it provides a holistic and timely view of the content of text submissions to r/abortion in 2022, highlighting the important role of r/abortion as an abortion-supportive online resource. As policies and pathways to abortion access continue to change across the US, approaches leveraging NLP with sufficiently large samples of textual data present opportunities for timely monitoring with the potential to reflect a broad range of abortion experiences, including those of people who have limited or no interaction with clinical abortion care. The second and third chapters present findings from hybrid inductive and deductive thematic qualitative analysis. The second chapter, “Discussion of social support in r/abortion: A qualitative exploration of narratives of social support in a Reddit-based online community for abortion in post-Dobbs leak,” presents results from an analysis of posts from r/abortion discussing social support to identify forms of interpersonal abortion support accessed, unmet support needs, and types of support sought and shared in r/abortion. These posts (n=503) spoke to the unmet needs for support from people’s clinical providers, partners, and families following the Dobbs leak, particularly for people using medication abortion. Additionally, this community was sometimes used as a platform for sharing social support by posting narratives of experience that sought to broaden understandings and expectations of abortion processes. The r/abortion community seemed to serve as an important place to discuss, seek, and share social support, but more and different support is needed, particularly informational and emotional support. The third chapter, “Lived experiences and consequences of abortion access barriers: A qualitative exploration of narratives shared in a Reddit community for abortion following the Dobbs leak in 2022,” explores discussions of barriers to abortion access and their impacts using the same 10% sample of posts and purposively sampled comments. In this sample of submissions (n=523 posts, 88 comments), people described structural barriers identified in past research, including state abortion bans and gestational limits, high costs, limited appointment availability, and long travel required. Posters also commonly described known social barriers, including limited social support and abortion stigma. Several impactful barriers not well-described in past research emerged inductively, including wait time for receiving mail-ordered medication abortion, low credibility of online ordering platforms, and concerns about legal risks of accessing abortion or related medical care. The most common consequences of experiencing barriers were adverse mental health outcomes, delayed access to care, and being compelled to self-manage their abortion because of barriers. This analysis provides timely insights into the experiences and impacts of abortion access barriers in a group of people with a range of engagement with clinical abortion care, lived experiences, and points in their abortion processes, with public health implications for mental health and abortion access.

    • Article
    • Peer Reviewed
    UC Berkeley Previously Published Works (2020)
    CONTEXT: Legal abortion restrictions, stigma and fear can inhibit peoples voices in clinical and social settings posing barriers to decision-making and abortion care. The internet allows individuals to make informed decisions privately. We explored what state-level policy dimensions were associated with volume of Google searches on abortion and on the abortion pill in 2018. METHODS: We used Google Trends to quantify the relative search volume (RSV) for abortion and abortion pill (or abortion pills hereafter referred to as abortion pill) as a proportion of total search volume for all queries in each US state. We also identified the top search queries most related to abortion and abortion pill and considered these as indicators of population concern. Key exposures were healthcare cost, access and health outcomes, and number of legal restrictions and protections at the state level. In descriptive analyses, we first grouped the states into tertiles according to their RSV on abortion and abortion pill. To examine the association between each exposure (and other covariates) with the two outcomes, we used unadjusted and adjusted linear regression. RESULTS: The average RSV for abortion in the low, moderate and high tertile groups was 48 (SD = 3.25), 55.5 (SD = 2.11) and 64 (SD = 4.72) (p-value <0.01) respectively; for abortion pill the average RSVs were 39.6 (SD = 16.68), 61.9 (SD = 5.82) and 81.7 (SD = 6.67) (p-value < 0.01) respectively. Concerns about contraceptive availability and access, and unplanned pregnancies independently predicted the relative search volumes for abortion and abortion pill. According to our baseline models, states with low contraceptive access had far higher abortion searches. Volume of abortion pill searches was additionally positively associated with poor health outcomes, poor access to abortion facilities and non-rurality. CONCLUSION: Search traffic analysis can help discern abortion-policy influences on population concerns and require close monitoring. State-policies can predict search volume for abortion and abortion pill. In 2018, concerns about contraceptives and unplanned pregnancies, predicted abortion searches. Current decreases in public contraceptive funding and the Title X Gag rule designed to block millions of people from getting care at Planned Parenthood, the largest provider of birth control and abortion care, may increase concerns about unintended pregnancies that can lead to increases in online relative volume of abortion searches.
      Cover page: Shining the light on abortion: Drivers of online abortion searches across the United States in 2018.
      • Article
      • Peer Reviewed
      UC Berkeley Previously Published Works (2021)
      BACKGROUND: In the United States, the internet is widely used to seek health information. Despite an estimated 18 million Google searches on abortion per year and the demonstrated importance of the abortion pill as an option for pregnancy termination, the top webpage search results for abortion pill searches, as well as the content and quality of those webpages, are not well understood. METHODS: We used Googles Custom Search Application Programming Interface (API) to identify the top 10 webpages presented for abortion pill searches on August 06, 2018. We developed a comprehensive, evidence-based Family Planning Webpage Quality Assessment Tool (FPWQAT), which was used to assess webpage quality for the five top webpages presenting text-based educational content. RESULTS: Of the top webpages for abortion pill searches, a plannedparenthood.com page was the top result and scored highest on our assessment (81%), providing high-quality and useable information. The other four webpages, a Wikipedia.com page and three anti-abortion information webpages, scored much lower on our assessment (14%-43%). These four webpages had lower quality of information in less useable formats. The anti-abortion pages also presented a variety of disinformation about the abortion pill. CONCLUSIONS: Both the lack of accurate clinical content on the majority of top webpages and the concerning disinformation they contained raise concerns about the quality of online abortion pill information, while underlining challenges posed by Google search results to informed choice for consumers. Healthcare providers and consumers must be informed of online abortion pill content that is not based in current clinical evidence, while advocates and policymakers should push for online information that is credible and useable. These changes are imperative given the importance of sound abortion pill information for reproductive decision-making at a time when in-person abortion services are further challenged in the US.
        Cover page: Quality of top webpages providing abortion pill information for Google searches in the USA: An evidence-based webpage quality assessment.Creative Commons 'BY' version 4.0 license
        • Article
        • Peer Reviewed
        UC Berkeley Previously Published Works (2022)
        BACKGROUND: As access barriers to in-person abortion care increase due to legal restrictions and COVID-19-related disruptions, individuals may be turning to the internet for information and services on out-of-clinic medication abortions. Google searches allow us to explore timely population-level interest in this topic and assess its implications. OBJECTIVE: We examined the extent to which people searched for out-of-clinic medication abortions in the United States in 2020 through 3 initial search terms: home abortion, self abortion, and buy abortion pill online. METHODS: Using the Google Trends website, we estimated the relative search index (RSI)-a comparative measure of search popularity-for each initial search term and determined trends and its peak value between January 1, 2020, and January 1, 2021. RSI scores also helped to identify the 10 states where these searches were most popular. We developed a master list of top search queries for each of the initial search terms using the Google Trends application programming interface (API). We estimated the relative search volume (RSV)-the search volume of each query relative to other associated terms-for each of the top queries using the Google Health Trends API. We calculated average RSIs and RSVs from multiple samples to account for low-frequency data. Using the Custom Search API, we determined the top webpages presented to people searching for each of the initial search terms, contextualizing the information found when searching them on Google. RESULTS: Searches for home abortion had average RSIs that were 3 times higher than self abortion and almost 4 times higher than buy abortion pill online. Interest in home abortion peaked in November 2020, during the third pandemic wave, at a time when providers could dispense medication abortion using telemedicine and by mail. Home abortion was most frequently queried by searching for Planned Parenthood, abortion pill, and abortion clinic, presumably denoting varying degrees of clinical support. Consistently lower search popularity for self abortion and buy abortion pill online reflect less population interest in mostly or completely self-managed out-of-clinic abortions. We observed the highest interest for home abortion and self abortion in states hostile to abortion, suggesting that state restrictions encourage these online searches. Top webpages provided limited evidence-based clinical content on self-management of abortions, and several antiabortion sites presented health-related disinformation. CONCLUSIONS: During the pandemic in the United States, there has been considerably more interest in home abortions than in minimally or nonclinically supported self-abortions. While our study was mainly descriptive, showing how infrequent abortion-related search data can be analyzed through multiple resampling, future studies should explore correlations between the keywords denoting interest in out-of-clinic abortion and abortion care measures and test models that allow for improved monitoring and surveillance of abortion concerns in our rapidly evolving policy context.
          Cover page: Exploring Google Searches for Out-of-Clinic Medication Abortion in the United States During 2020: Infodemiology Approach Using Multiple Samples.Creative Commons 'BY' version 4.0 license
          • Article
          • Peer Reviewed
          UC Berkeley Previously Published Works (2023)

          Background

          Contraceptive choice is central to reproductive autonomy. The internet, including social networking sites like Reddit, is an important resource for people seeking contraceptive information and support. A subreddit dedicated to contraception, r/birthcontrol, provides a platform for people to post about contraception.

          Objective

          This study explored the use of r/birthcontrol, from the inception of the subreddit through the end of 2020. We describe the web-based community, identify distinctive interests and themes based upon the textual content of posts, and explore the content of posts with the most user engagement (ie, "popular" posts).

          Methods

          Data were obtained from the PushShift Reddit application programming interface from the establishment of r/birthcontrol to the start date of analysis (July 21, 2011, to December 31, 2020). User interactions within the subreddit were analyzed to describe community use over time, specifically the commonality of use based on the volume of posts, the length of posts (character count), and the proportion of posts with any and each flair applied. "Popular" posts on r/birthcontrol were determined based on the number of comments and "scores," or upvotes minus downvotes; popular posts had 9 comments and a score of ≥3. Term Frequency-Inverse Document Frequency (TF-IDF) analyses were run on all posts with flairs applied, posts within each flair group, and popular posts within each flair group to characterize and compare the distinctive language used in each group.

          Results

          There were 105,485 posts to r/birthcontrol during the study period, with the volume of posts increasing over time. Within the time frame for which flairs were available on r/birthcontrol (after February 4, 2016), users applied flairs to 78% (n=73,426) of posts. Most posts contained exclusively textual content (n=66,071, 96%), had comments (n=59,189, 86%), and had a score (n=66,071, 96%). Posts averaged 731 characters in length (median 555). "SideEffects!?" was the most frequently used flair overall (n=27,530, 40%), while "Experience" (n=719, 31%) and "SideEffects!?" (n=672, 29%) were most common among popular posts. TF-IDF analyses of all posts showed interest in contraceptive methods, menstrual experiences, timing, feelings, and unprotected sex. While TF-IDF results for posts with each flair varied, the contraceptive pill, menstrual experiences, and timing were discussed across flair groups. Among popular posts, intrauterine devices and contraceptive use experiences were often discussed.

          Conclusions

          People commonly wrote about contraceptive side effects and experiences using methods, highlighting the value of r/birthcontrol as a space to post about aspects of contraceptive use that are not well addressed by clinical contraceptive counseling. The value of real-time, open-access data on contraceptive users' interests is especially high given the shifting landscape of and increasing constraints on reproductive health care in the United States.
            Creative Commons 'BY' version 4.0 license
            • Article
            • Peer Reviewed
            UC Berkeley Previously Published Works (2019)

            Background

            Despite improvements in contraception availability, women face persistent barriers that compromise reproductive autonomy and informed choice. Provider bias is one way in which access to contraception can be restricted within clinical encounters and has been established as common in sub-Saharan Africa. This analysis assessed the prevalence of provider restrictions and the potential impact on women's method uptake in Lomé, Togo.

            Methods

            This sub-analysis used survey data from provider and client interviews collected to assess the impacts of the Agir pour la Planification Familiale (AgirPF) program in Togo. The relationships between provider restrictiveness and women's receipt of their desired method of contraception were modelled using mixed effects logistic regressions looking at all women and among subgroups hypothesized to be at potentially higher risk of bias.

            Results

            Around 84% of providers reported a restriction in contraceptive provision for the five contraceptive methods explored (pill, male condom, injectable, IUD, and implant). Around 53% of providers reported restricting at least four of the five methods based on age, parity, partner consent, or marital status. Among all women, there were no significant associations between provider restrictiveness and women's receipt of desired method, including among those who desired long-acting methods. In adjusted modeling, marital status was a covariate significantly associated with desired method, with married women more likely to receive their desired method than unmarried women (aOR 2.73, 95% CI 1.45-5.13).

            Conclusion

            Provider reports of high levels of restrictions in this population are concerning and should be further explored, especially its effects on unmarried women. However, restrictions reported by providers in this study did not appear to statistically significantly influence contraceptive method received.
              Cover page: Are Women In Lomé Getting Their Desired Methods Of Contraception? Understanding Provider Bias From Restrictions To Choice.
              • Article
              • Peer Reviewed
              UC Berkeley Previously Published Works (2024)
              With drastic changes to abortion policy, the months following the Dobbs leak and subsequent decision in 2022 were a uniquely uncertain and difficult time for abortion access in the United States. To understand experiences of challenges to abortion access during that time, we used a hybrid inductive and deductive thematic coding approach to analyse descriptions of barriers and their impacts shared in an abortion subreddit (r/abortion). A simple random sample of 10% of posts was obtained from those shared from 02 May 2022 through 23 December 2022; comments were purposively sampled during the coding process. In this sample of submissions (n = 523 posts, 88 comments), people described structural barriers identified in past research, including state abortion bans and gestational limits, high costs, limited appointment availability, and long travel required. Posters also commonly described known social barriers, including limited social support and abortion stigma. Several impactful barriers not well-described in past research emerged inductively, including wait time for receiving mail-ordered abortion medication, low credibility of online ordering platforms, and concerns about legal risks of accessing abortion or related medical care. The most common consequences of experiencing barriers were adverse mental health outcomes, delayed access to care, and being compelled to self-manage their abortion because of access barriers. This analysis provides timely insights into the experiences and impacts of abortion access barriers in a group of people with a range of engagement with clinical abortion care, lived experiences, and points in their abortion processes, with public health implications for mental health and abortion access.
                Cover page: Abortion access barriers shared in r/abortion after Roe: a qualitative analysis of a Reddit community post-Dobbs decision leak in 2022.
                • Article
                • Peer Reviewed
                UC Berkeley Previously Published Works (2020)
                Studies demonstrate that dental providers value effective provider-patient communication but use few recommended communication techniques. This study explored perspectives of California dental providers and oral health literacy experts in the United States on use of communication techniques. We conducted a qualitative key informant interview study with 50 participants between November 2019 and March 2020, including 44 dental providers (dentists, hygienists, and assistants) in public or private practice in California and 6 oral health literacy (OHL) experts. We undertook thematic analysis of interview transcripts and descriptive statistics about interviewees from pre-surveys. Dental providers reported frequently speaking slowly, and using simple language and models/radiographs to communicate with patients, while infrequently using interpretation/translation, illustrations, teach-back, or motivational interviewing. Providers reported using only 6 of the 18 American Medical Association's (AMA) recommended communication techniques and only 3 of the 7 AMA's basic communication techniques. A majority of providers indicated using one of five oral health assessment and educational strategies. Key barriers to effective communication included limited time, financial incentives promoting treatment over prevention, lack of OHL training, limited plain-language patient education materials, and patients with low OHL knowledge. Dental organizations should prioritize supporting dental providers in effective patient communication practices. Standardizing OHL continuing education, creating an evidence-based OHL toolkit for dental teams, ensuring accessible interpretation/translation services, and incentivizing dental providers to deliver education could improve oral health literacy and outcomes.
                  Cover page: Barriers and Facilitators to Promoting Oral Health Literacy and Patient Communication among Dental Providers in California.
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