New York City Physicians' Views of Providing Long-Acting Reversible Contraception to Adolescents

Abstract

PURPOSE Although the US adolescent pregnancy rate is high, use of the most effective reversible contraceptives-intrauterine devices (IUDs) and implantable contraception-is low. Increasing use of long-acting reversible contraception (LARC) could decrease adolescent pregnancy rates. We explored New York City primary care physicians' experiences, attitudes, and beliefs about counseling and provision of LARC to adolescents. METHODSWe conducted in-depth telephone interviews with 28 family physicians, pediatricians, and obstetrician-gynecologists using an interview guide based on an implementation science theoretical framework. After an iterative coding and analytic process, fi ndings were interpreted using the capability (knowledge and skills), opportunity (environmental factors), and motivation (attitudes and beliefs) conceptual model of behavior change. RESULTSEnablers to IUD counseling and provision include knowledge that nulliparous adolescents are appropriate IUD candidates (capability) and opportunity factors, such as (1) a clinical environment supportive of adolescent contraception, (2) IUD availability in clinic, and (3) the ability to insert IUDs or easy access to an someone who can. Factors enabling motivation include belief in the overall positive consequences of IUD use; this is particularly infl uenced by a physicians' perception of adolescents' risk of pregnancy and sexually transmitted disease. Physicians rarely counsel about implantable contraception because of knowledge gaps (capability) and limited access to the device (opportunity).CONCLUSION Knowledge, skills, clinical environment, and physician attitudes, all infl uence the likelihood a physician will counsel or insert LARC for adolescents. Interventions to increase adolescents' access to LARC in primary care must be tailored to individual clinical practice sites and practicing physicians, the methods must be made more affordable, and residency programs should offer up-to-date, evidence-based teaching.

Evidence-Based Selection of Candidates for the Levonorgestrel Intrauterine Device (IUD)

“…The direction of these associations is consistent with studies indicating that physicians farther from their training are less likely to insert IUDs 18 and more likely to have misperceptions about IUDs 25 ; however, the lack of significance in 3 models suggests either a lack of a true association or insufficient sample size to detect significance. In a similar way, the direction of the associations between accurate general knowledge and routinely recommending the LNG-IUS was positive in the 4 models but the association was significant only for nulliparous women; this may indicate that accurate knowledge alone does not consistently predict evidence-based practices 28,29 or may be due to sample size. Further investigation in a larger sample is warranted to clarify these observed associations.…”

“…In that survey, providers reported accurate knowledge about the safety of IUDs in teens but often remained unwilling to recommend IUDs to teens. Using qualitative interviews with primary care physicians, Rubin et al 29 developed a conceptual framework of factors influencing IUD practices related to teens. Highlighting the independent roles of both accurate knowledge and perceptions of the risks and benefits of IUDs, they concluded that interventions should address both knowledge gaps and negative attitudes and be tailored to individual practice sites.…”

Counseling Adolescents About the Intrauterine Contraceptive Device

“…Survey items were organized around Capability, Opportunity, Motivation (COM) implementation science theoretical framework 25 used in our prior work. 16 The COM framework was developed in order to systematically improve the design of behavior change interventions.…”

Intrauterine Devices at Six Months: Does Patient Age Matter? Results from an Urban Family Medicine Federally Qualified Health Center (FQHC) Network

“…8 Established challenges to providing IUDs include limited access to providers trained in insertion (including FQHCs) 5 , and practitioner concerns that, as compared to adults, adolescent IUD users will (1) not tolerate expected device related side effects, (2) experience more expulsion especially due to nulliparity and (3) have increased risk of sexually transmitted infections (STIs), including pelvic inflammatory disease. 9-17 …”