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Assessing Factors Influencing Condom Use Among Young Long-Acting Reversible Contraception Users
282
Poster Abstracts / J Pediatr Adolesc Gynecol 30 (2017) 275e298
Sexual history was documented in 45.9% of charts. Menarche, menses frequency, menses duration, flow quantity, and dysmenorrhea were rarely documented, regardless of patient age or medical complexity. Providers were more likely to document menses if the patient’s chief complaint was abdominal pain (41.7%, p<0.05). Mental health complaints were associated with an increase in sexual history documentation (62.9%, p<0.001) and a non-significant decrease in menses documentation (25.8%, p¼0.08). The general pediatric service had higher rates of documenting menses (36.2%, p¼0.05) and sexual histories (51.9%, p¼0.01) compared to other services. Admissions in which gynecology was consulted were also more likely to contain menses documentation (73.3%, p¼0.01) in the admission history. Conclusions: Despite recommendations, menstrual history remains poorly documented for adolescent females admitted to the hospital across multiple specialties. Patterns of menses documentation differed from patterns of sexual history documentation, indicating sexual history is not a surrogate for menstrual history. Clinicians were more likely to document menses for patients with abdominal pain, though this was still found in less than half the charts. These low rates of menstrual history documentation provide an opportunity for quality improvement.
Chief Complaint Abdominal Mental Pain Health Menses Documentation Rate P value Sexual Documentation Rate P value
41.7% 25.8% 33.3% 14.3% <0.05
0.08
0.96
0.06
50.0% 62.9% 41.7% 14.3% 0.39 <0.001
Admitting Service
Infection Trauma Emesis
0.66
0.003
Pediatrics Surgery Psychiatry
41.2% 36.2% 0.45
0.05
41.2% 51.9% 0.69
0.001
32.7%
9.1%
0.98
0.11
32.7% 27.3% 0.03
0.20
16. Assessing Factors Influencing Condom Use Among Young Long-Acting Reversible Contraception Users Shandhini Raidoo MD* University of Hawai’i John A. Burns School of Medicine, Honolulu, HI
Background: Dual use, the use of condoms for STI prevention and nonbarrier contraception for pregnancy prevention, is lowest among users of long-acting reversible contraceptive (LARC) methods. LARC methods are becoming increasingly popular among young women because they are easy to use and highly effective at pregnancy prevention. They do not, however, protect against sexually transmitted infections (STIs), which disproportionately affect young women. The decision to use condoms in addition to a LARC method is complex and can be influenced by a variety of personal, partner, and social factors. An understanding of these factors is necessary to encourage and improve dual use practices. Methods: This study was approved by the University of Hawai’i IRB, study number CHS #23198. Individual, semi-structured interviews about sexual health, contraception, condom use, and STIs were conducted in young women using LARC methods of contraception. The interviews were analyzed through the iterative process of qualitative analysis to identify common themes and ideas related to dual use. Results: Twelve young women aged 14-24 who were currently using LARC methods for contraception were interviewed. Common themes included using condoms primarily for pregnancy prevention and discontinuing condom use when initiating a non-barrier method of contraception. Those who did use condoms regularly were confident when negotiating with partners about condom use. Most participants did not perceive themselves to be at risk of acquiring STIs. All participants were able to identify general STI risks and preventive measures. Concerns about trust and intimacy in relationships and decreased personal and partner satisfaction with condom use were expressed. Participants expressed the need for improved sexual and reproductive health education to address contraception use and STI prevention.
Conclusions: Perception of risk for STI acquisition plays a major role in the decision to use condoms among LARC users, as do partner and relationship considerations. Young LARC users are knowledgeable about STI risks and prevention but do not regularly practice preventive behaviors in their sexual relationships. Partners are influential in dual use decisionmaking.
17. Theory Based Educational Comic for Intrauterine Device Information: Perspectives of Primary Care Providers Aparna Sridhar MD, MPH*1, Alice Brown BA 2, Karen Roque MPH 3 1
Assistant Professor in Obstetrics and Gynecology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 2 Medical Student, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 3 Title X Health Educator, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
Background: Comics can help young readers by combining pictures and words, giving visual cues as to what the text is explaining. Narrative communication in comics has been used with moderate success to educate readers about various health issues. Methods: We developed a comic in consultation with an illustrator to educate adolescents and young adults about intrauterine device (IUD) information with theoretical concepts of health belief model and social cognitive theory. The comic simulates a typical interaction with healthcare provider where the lead character will express her concerns about an IUD to a physician. In this process she expresses her perspective about IUDs, both positive and negative, based on her interactions with her friends, family, internet and social media. The healthcare provider then counsels her with structured information about IUDs. The provider also informs about additional use of condoms as the only contraception preventing sexually transmitted infections (Figure 1 and 2). With the completion of comic development, we obtained IRB exempt to pilot test the comic for face validity, among primary care providers at our academic medical center. A convenient sample of twenty five primary care providers was recruited to review the comic and evaluate it with a cross-sectional survey using a likert scale of 1-5 (5¼maximum positive score). Results: Fifteen physicians and 10 nurse practitioners participated in the study. All of them counseled women on contraceptive methods frequently. The comic was really liked (mean score 4.96) by providers. They felt that the comic was successful in providing information about the types of IUDs (4.64), its effectiveness (4.68), mechanism of action (4.68), risks/benefits (4.4) and placement details (4.56). The comic scored high mean scores when evaluated for its color (4.52), images (4.52), layout (4.48) and overall look (4.4). Providers in the study strongly believed that seeing this comic prior to IUD insertion would be helpful and seeing this comic will be helpful in improving the IUD knowledge of their patients.
Fig 1. Mechanism of Action.Ă
Poster Abstracts / J Pediatr Adolesc Gynecol 30 (2017) 275e298
Sexual history was documented in 45.9% of charts. Menarche, menses frequency, menses duration, flow quantity, and dysmenorrhea were rarely documented, regardless of patient age or medical complexity. Providers were more likely to document menses if the patient’s chief complaint was abdominal pain (41.7%, p<0.05). Mental health complaints were associated with an increase in sexual history documentation (62.9%, p<0.001) and a non-significant decrease in menses documentation (25.8%, p¼0.08). The general pediatric service had higher rates of documenting menses (36.2%, p¼0.05) and sexual histories (51.9%, p¼0.01) compared to other services. Admissions in which gynecology was consulted were also more likely to contain menses documentation (73.3%, p¼0.01) in the admission history. Conclusions: Despite recommendations, menstrual history remains poorly documented for adolescent females admitted to the hospital across multiple specialties. Patterns of menses documentation differed from patterns of sexual history documentation, indicating sexual history is not a surrogate for menstrual history. Clinicians were more likely to document menses for patients with abdominal pain, though this was still found in less than half the charts. These low rates of menstrual history documentation provide an opportunity for quality improvement.
Chief Complaint Abdominal Mental Pain Health Menses Documentation Rate P value Sexual Documentation Rate P value
41.7% 25.8% 33.3% 14.3% <0.05
0.08
0.96
0.06
50.0% 62.9% 41.7% 14.3% 0.39 <0.001
Admitting Service
Infection Trauma Emesis
0.66
0.003
Pediatrics Surgery Psychiatry
41.2% 36.2% 0.45
0.05
41.2% 51.9% 0.69
0.001
32.7%
9.1%
0.98
0.11
32.7% 27.3% 0.03
0.20
16. Assessing Factors Influencing Condom Use Among Young Long-Acting Reversible Contraception Users Shandhini Raidoo MD* University of Hawai’i John A. Burns School of Medicine, Honolulu, HI
Background: Dual use, the use of condoms for STI prevention and nonbarrier contraception for pregnancy prevention, is lowest among users of long-acting reversible contraceptive (LARC) methods. LARC methods are becoming increasingly popular among young women because they are easy to use and highly effective at pregnancy prevention. They do not, however, protect against sexually transmitted infections (STIs), which disproportionately affect young women. The decision to use condoms in addition to a LARC method is complex and can be influenced by a variety of personal, partner, and social factors. An understanding of these factors is necessary to encourage and improve dual use practices. Methods: This study was approved by the University of Hawai’i IRB, study number CHS #23198. Individual, semi-structured interviews about sexual health, contraception, condom use, and STIs were conducted in young women using LARC methods of contraception. The interviews were analyzed through the iterative process of qualitative analysis to identify common themes and ideas related to dual use. Results: Twelve young women aged 14-24 who were currently using LARC methods for contraception were interviewed. Common themes included using condoms primarily for pregnancy prevention and discontinuing condom use when initiating a non-barrier method of contraception. Those who did use condoms regularly were confident when negotiating with partners about condom use. Most participants did not perceive themselves to be at risk of acquiring STIs. All participants were able to identify general STI risks and preventive measures. Concerns about trust and intimacy in relationships and decreased personal and partner satisfaction with condom use were expressed. Participants expressed the need for improved sexual and reproductive health education to address contraception use and STI prevention.
Conclusions: Perception of risk for STI acquisition plays a major role in the decision to use condoms among LARC users, as do partner and relationship considerations. Young LARC users are knowledgeable about STI risks and prevention but do not regularly practice preventive behaviors in their sexual relationships. Partners are influential in dual use decisionmaking.
17. Theory Based Educational Comic for Intrauterine Device Information: Perspectives of Primary Care Providers Aparna Sridhar MD, MPH*1, Alice Brown BA 2, Karen Roque MPH 3 1
Assistant Professor in Obstetrics and Gynecology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 2 Medical Student, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 3 Title X Health Educator, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
Background: Comics can help young readers by combining pictures and words, giving visual cues as to what the text is explaining. Narrative communication in comics has been used with moderate success to educate readers about various health issues. Methods: We developed a comic in consultation with an illustrator to educate adolescents and young adults about intrauterine device (IUD) information with theoretical concepts of health belief model and social cognitive theory. The comic simulates a typical interaction with healthcare provider where the lead character will express her concerns about an IUD to a physician. In this process she expresses her perspective about IUDs, both positive and negative, based on her interactions with her friends, family, internet and social media. The healthcare provider then counsels her with structured information about IUDs. The provider also informs about additional use of condoms as the only contraception preventing sexually transmitted infections (Figure 1 and 2). With the completion of comic development, we obtained IRB exempt to pilot test the comic for face validity, among primary care providers at our academic medical center. A convenient sample of twenty five primary care providers was recruited to review the comic and evaluate it with a cross-sectional survey using a likert scale of 1-5 (5¼maximum positive score). Results: Fifteen physicians and 10 nurse practitioners participated in the study. All of them counseled women on contraceptive methods frequently. The comic was really liked (mean score 4.96) by providers. They felt that the comic was successful in providing information about the types of IUDs (4.64), its effectiveness (4.68), mechanism of action (4.68), risks/benefits (4.4) and placement details (4.56). The comic scored high mean scores when evaluated for its color (4.52), images (4.52), layout (4.48) and overall look (4.4). Providers in the study strongly believed that seeing this comic prior to IUD insertion would be helpful and seeing this comic will be helpful in improving the IUD knowledge of their patients.
Fig 1. Mechanism of Action.Ă