Angela Dempsey

Predictors of long-acting reversible contraception use among unmarried young adults

OBJECTIVE The objective of the study was to improve the understanding of long-acting reversible contraception (LARC) use patterns among unmarried, young adults at risk of unintended pregnancy. STUDY DESIGN We performed a secondary data analysis of a national survey conducted by Guttmacher Institute of unmarried women and men aged 18-29 years. LARC is defined as an intrauterine device (IUD) or implant. Predictors of LARC use and IUD knowledge among those at risk for unintended pregnancy (n = 1222) were assessed using χ(2) analysis and logistic regression models. RESULTS LARC use was associated with older age, high IUD knowledge, and earlier onset of sexual activity. Respondents with high IUD knowledge were 6 times more likely to be current LARC users (odds ratio [OR], 6.3; 95% confidence interval [CI], 1.4-28.8). Sociodemographic variables did not predict use. Respondents with lower education (OR, 1.76; 95% CI, 1.0-3.0), an external locus of control (OR, 1.6; 95% CI, 1.1-2.3), male sex (OR, 2.8; 95% CI, 1.9-4.1), and foreign language had less knowledge of IUD. CONCLUSION Increasing knowledge of IUD among certain groups may improve LARC use among young, unmarried adults and in turn decrease unintended pregnancy.

Predicting Oral Contraceptive Continuation Using The Transtheoretical Model of Health Behavior Change

CONTEXT Improved continuation of oral contraceptive use may decrease the incidence of unintended pregnancy. Therefore, identifying predictors of continuation is important to informing targeted interventions. METHODS A survey conducted in 2003-2005 collected data from young women who sought oral contraceptives at three family planning clinics in New York, Dallas and Atlanta. Cluster analysis of data from 1,245 women was used to identify three distinct groups on the basis of baseline responses to items measuring constructs from the transtheoretical model of health behavior change: perceived advantages of pill use, perceived disadvantages and self-confidence in ability to sustain use. Logistic regression was used to assess the likelihood of continuation among the clusters. RESULTS Participants who were confident in their ability to use the pill and who considered both its advantages and its disadvantages important were more likely to continue use for six months than were those who gave low scores to the methods advantages and their ability to use it (odds ratio, 1.4). The same appeared to be true for those who gave high scores to the pills advantages and their ability to use it, but a low score to the methods disadvantages (1.3); however, this finding was only marginally significant. Demographic variables were not significant after adjustment for cluster membership. CONCLUSIONS Cluster membership based on transtheoretical model constructs helps predict oral contraceptive continuation. Women who undervalue the advantages of pill use and have low confidence in their ability to use the method represent a target for interventions and future research.

Vaginal estrogen supplementation during Depo-Provera initiation: a randomized controlled trial.

BACKGROUND Irregular bleeding is often cited as the reason for discontinuation of depot-medroxyprogesterone acetate (DMPA) after the first injection. Estrogen supplementation during DMPA initiation may decrease bleeding and improve continuation. STUDY DESIGN This prospective, randomized, controlled trial evaluated estrogen supplementation during DMPA initiation. Women initiating DMPA were randomized to receive an estradiol vaginal ring for 3 months versus DMPA alone. Bleeding diaries and questionnaires at three and 6 months assessed bleeding, continuation and ring acceptability. RESULTS Seventy-one participants enrolled; 49 completed the first follow-up period. The median number of bleeding or spotting days was 16 in the estrogen ring group (n=26) versus 28 in the DMPA alone group (n=23) (p=.19). Seventy-seven percent of the intervention group received a second injection compared with 70% in the DMPA alone group (p=.56). For each additional day of bleeding and/or spotting reported, women were 3% less likely to receive a second injection (OR 0.97, 95% CI 0.94-0.99). Acceptability of the vaginal ring was high among those in the intervention group. CONCLUSIONS Vaginal estrogen supplementation during DMPA initiation is acceptable to women and may decrease total bleeding.

The influence of trust in health care systems on postabortion contraceptive choice.

OBJECTIVES This study investigates whether trust in the health care system or other patient-level characteristics are associated with interest in immediate initiation of long-acting reversible contraception (LARC) after abortion. STUDY DESIGN A structured, self-administered survey was provided to English-speaking women 18 years or older presenting to a reproductive health center in the Southeastern United States for first-trimester surgical abortion. The survey collected information about patient characteristics, choice of postabortion contraception, health literacy and trust in the health care system. Trust was measured using a 17-item, previously validated survey and was treated as the primary independent variable. Our primary outcome variable is interest in immediate LARC placement postabortion. Statistical analysis was performed using Chi-square tests, Students t tests and logistic regression with SAS® 9.2. RESULTS Of 162 respondents who completed the survey, 24% planned to use LARC postabortion, which increased to 37% if LARC placement was available on the day of their abortion. The mean trust score was 59±8 (possible score of 17-85) and did not differ significantly between women who indicated an interest in immediate LARC placement postabortion and those who did not (p=.9). Women with a history of a prior birth were 3.4 times more likely to indicate interest in immediate postabortion LARC than others (adjusted odds ratio 3.42, 95% confidence interval 1.63, 7.18). CONCLUSION Desire to accept LARC immediately postabortion is associated with history of a prior birth but not with trust in the health care system or other demographic variables. Participant interest in postabortion LARC varied based on immediate device availability. IMPLICATIONS This research underscores the importance of policies and clinical practices that promote access to LARC methods on the day of an abortion. Further research is needed to elucidate factors that correlate with choice of LARC postabortion.

A qualitative analysis of postpartum contraceptive choice

ABSTRACT Background: The World Health Organization recommends a minimum 24-month birth-to-pregnancy interval to improve maternal and child health. Postpartum contraception is a mechanism to achieve optimal birth spacing and prevent unintended pregnancy, which may reduce health disparities and inequalities in health status among new mothers and their children. This study investigated women’s communication channel preferences, as well as patient engagement and shared decision making about contraceptive method choice and use in the postpartum period. Method: Researchers conducted six focus groups with 47 women receiving postpartum care at an outpatient clinic. A semi-structured focus group protocol was created and tested. A constant comparative approach provided an inductive method of analysis. HyperRESEARCH 3.5.2 qualitative data analysis software facilitated coding based on the health belief model. Results: Participants included women 18–39 years of age with an average of 1.7 children. The majority of participants utilized Medicaid (53%) and self-identified as Black (49%) or White (43%). Participants discussed interpersonal, mass media, and new media channels featuring messages about contraception, including long-acting reversible contraception (LARC). These women negotiated complex social norms, including preferring the Internet as a primary source of information and avoiding mass media. Participants balanced messages from social networks, including physician counseling and the power of personal experiences of friends and family in contraceptive decision making. Conclusions: This study demonstrated women perceive the voices of lay experts online as the most influential source of information and prefer to receive contraceptive information online and in-person during the prenatal and postpartum period.

“My Body. My Choice”: A Qualitative Study of the Influence of Trust and Locus of Control on Postpartum Contraceptive Choice

Postpartum contraception helps reduce unintended pregnancy and space births to improve maternal and child health. This study explored women’s perceptions of contraceptive choice during the postpartum period in the context of locus of control and trust in healthcare providers. Researchers conducted six focus groups with 47 women, ages 18–39, receiving postpartum care at an outpatient clinic. Techniques from grounded theory methodology provided an inductive approach to analysis. HyperRESEARCH 3.5.2 qualitative data analysis software facilitated a constant-comparative coding process to identify emergent themes. Participants expressed a preference for relationship-centered care, in which healthcare providers listened, individualized their approach to care through rapport-building, and engaged women in shared decision-making about contraceptive use through open communication, reciprocity, and mutual influence. Conflicting health messages served as barriers to uptake of effective contraception. While participants trusted their healthcare provider’s advice, many women prioritized personal experience and autonomy in decisions about contraception. Providers can promote trust and relationship-centered care to optimize contraceptive uptake by listening, exploring patient beliefs and preferences about contraception and birth spacing, and tailoring their advice to individuals. Results suggest that antenatal contraceptive counseling should incorporate information about effectiveness, dispel misconceptions, and engage patients in shared decision-making.