Contraceptive decision-making and priorities: What happens before patients see a healthcare provider

Abstract

Extensive research has been conducted on the contraceptive decision-making that patients engage in during their appointment with healthcare providers and the approaches used by providers during this process, but less information is available on what happens prior to the appointment that may contribute to patients’ decisions. Here, we use data from semi-structured interviews with 17 patients at a sexual health clinic about their experience obtaining contraception to explore the process of choosing a method. Participants were recruited through posters in the clinic waiting room and via information posted on the clinic’s social media feeds. Interviews were thematically analyzed, and two main themes identified. The first theme was the importance of seeking out information online and from social networks prior to seeing a provider, to the extent that most participants had settled on a method prior to their discussion with a physician. The second theme was the priorities identified by participants in their decision-making, primarily side effects. The findings suggest that key moments of decision-making may not take place during a contraceptive counselling appointment, but rather beforehand through independent research, discussions with others, and previous experiences with contraception. The experiences of participants in this study indicate that contraceptive counselling should include discussion of the information patients have gleaned from other sources and acknowledge the importance of experiential information as well as factual.

Effect of knowledge level on IUD contraceptive use in women of childbearing age

“…Some women may fear side effects that do not actually occur or have incorrect information about the procedure. Proper education can help dispel this myth and provide a clear and accurate picture of IUDs (Fulcher et al, 2021).…”

Claims in the clinic: A qualitative group interview study on healthcare communication about unestablished side effects of the copper IUD

“…Researchers have also argued that dominant paradigms in contraceptive care may rely on a narrow definition of scientific evidence, and that in order to be appropriate and patient-centered it should also engage with evidence grounded in patients’ experiential knowledge [ 33 , 74 ]. Invoking reproductive justice, Fulcher et al [ 128 ] state that contraceptive counselling should acknowledge the importance of experiential information, and include discussion of accounts patients may have received from different sources [ 128 ]. It has been noted that while many patients, across racialized and class groups [ 27 ], prioritize embodied experience in contraceptive decision-making [ 25 ], although it is often combined with available biomedical knowledge [ 55 ], the reliance on epistemically privileged biomedical knowledge enables the overlooking of patient experiences, including the understanding of perceived side effects in terms of fabrications or misconceptions [ 27 , 32 , 106 ].…”

The different facets of ‘experiential knowledge’ in Swedish women’s claims about systemic side effects of the copper intrauterine device

“…As patient groups increasingly claim the status of ‘experts of experience’ (Rabeharisoa et al., 2014), a ‘rising trust in experiential knowledge’ (Mahr, 2021, p. 36) can be identified among scholars (Prior, 2003) and policy bodies too (Blume, 2017; Caron‐Flinterman et al., 2005). Arguments have been made for the incorporation of patient perspectives and experiences in health care (Miles & Loughlin, 2011) and medical research (Staniszewska & Söderholm Werkö, 2021), not least in reproductive health and contraceptive counselling (Downey et al., 2017; Fulcher et al., 2021). Pleas in favour of the active participation of patients in biomedical research processes have also been made by governmental bodies (Caron‐Flinterman et al., 2005), largely with reference to patient contributions to the relevance and quality of biomedical research.…”