Barriers to and enablers of contraceptive use among adolescent females and their interest in an emergency department based intervention

Abstract

Objective Over 15 million adolescents, many at high risk for pregnancy, use emergency departments (ED) in the United States annually, but little is known regarding reasons for failure to use contraceptives in this population. The purpose of this study was to identify the barriers to and enablers of contraceptive use among adolescent females using the ED and determine their interest in an ED-based pregnancy prevention intervention. Study Design We conducted semi-structured, open-ended interviews with females in an urban ED. Eligible females were 14-19 years old, sexually active, presenting for reproductive health complaints, and at risk for pregnancy, defined as non-use of effective (per the World Health Organization) contraception. Interviews were recorded, transcribed, and coded based on thematic analysis. Enrollment continued until no new themes emerged. A modified Health Belief Model guided the organization of the data. Results Participants (n=14) were predominantly Hispanic (93%), insured (93%), and in a sexual relationship (86%). The primary barrier to contraceptive use was perceived health risk, including effects on menstruation, weight, and future fertility. Other barriers consisted of mistrust in contraceptives, ambivalent pregnancy intentions, uncertainty about the future, partner's desire for pregnancy, and limited access to contraceptives. Enablers of past contraceptive use included the presence of a school-based health clinic and clear plans for the future. All participants were receptive to ED-based pregnancy prevention interventions. Conclusions The identified barriers and enablers influencing hormonal contraceptive use can be used to inform the design of future ED-based adolescent pregnancy prevention interventions.

Examining the Role of the Pediatric Emergency Department in Reducing Unintended Adolescent Pregnancy

“…Our findings are consistent with prior studies that demonstrate adolescent receptiveness towards receipt contraceptive services in the ED. 15, 1816, 17, 19 Furthermore, our study was unique in its inquiry regarding adolescent interest in using an ED-based reproductive health clinic, a concept supported by the majority of study participants.…”

A Qualitative Systematic Review of Women's Experiences Using Contraceptive Vaginal Rings: Implications for New Technologies

“…Because a given factor (e.g., access to contraceptive services) could be perceived as either a barrier (if access is lacking) or a facilitator (if access is good), depending on the context, our classifi cations methods, 37 long-acting reversible contraceptives 42,46,49,52 or contraceptives in general (i.e., both hormonal and nonhormonal methods). 29,[31][32][33][34][35][36]38,39,43,44,48,50,51 In many of the studies, information about the ring was limited to brief summaries, along with a few illustrative examples and quotes (sometimes only one) pertaining to the method.…”

Factors Associated With Interest in Same-Day Contraception Initiation Among Females in the Pediatric Emergency Department

“…4–5 Many adolescents cared for in EDs report patient- and system-level factors associated with increased pregnancy risk including early initiation of sexual activity, infrequent or inconsistent contraception use, violence victimization and lack of access to regular care. 6–8 Previous adolescent relationship abuse (ARA) victimization among female adolescents in the pediatric ED is common 9–11 and those reporting ARA are more likely to be sexually experienced and less likely to have used condoms, compared to females without ARA history. 6 …”

“…11,14–17 Further, ED-based interventions targeting sexual health and pregnancy prevention are highly acceptable among adolescent ED users and their parents. 3,8, 18–19 …”