- Email: [email protected]
Intrauterine device knowledge, attitudes and experience among senior obstetrics and gynecology residents
Abstracts / Contraception 78 (2008) 167–195 Methods: Between December 2007 and March 2008, we conducted 21 focus groups with African-American parents and their adolescents aged 15–17 in Pittsburgh, PA. Groups were stratified by gender and participant type, and were audio recorded, transcribed and analyzed using the grounded theory approach to content analysis. Atlas.Ti was used for coding and creating data matrices to compare themes across gender and participant type. Results: Parents and adolescents differed markedly in their recall of discussions about these topics. Adolescents generally reported that parents— particularly mothers — had communicated their values and expectations regarding the use of contraception and abortion. However, parents found these topics difficult and reported discussing them infrequently. Parents addressed these issues primarily when teachable moments arise, such as if a child's physician brought up these subjects, if a teen within the family's social network became pregnant, had an abortion or was discovered to be using contraception. Conclusions: Parents infrequently communicate directly with their children about contraception and abortion. However, children are clearly aware of their parent's values and expectations regarding these topics. These findings suggest that providers should continue providing family planning counseling to adolescents and should consider counseling assisting parents to develop skills for addressing these topics.
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Objectives: With the exact mechanisms of action of hormonal contraception still unknown and with evidence both for and against postfertilization effects, it is important to assess how influential postfertilization effects are to female adolescents' choice of contraception. Methods: We conducted 30-min face-to-face interviews with 196 female adolescents, aged 13 to 21 years, from an outpatient adolescent clinic to determine what they know about the mechanisms of action of various methods of contraception and what their attitudes are regarding different mechanisms of action. Results: Participants had a knowledge level of 8.49±3.68 (range 0–20) for the mechanism of actions of various methods. Although the majority of participants could not categorize accurately the 18 different contraceptive's mechanism of action, there was a correlation between the method's mechanism and the method participants intended to use. Over half (59.2%) said that their choice to stop or continue using a method depended on how often the method works after fertilization but before implantation with 39.3% saying they would “definitely not use something to prevent pregnancy that works after implantation.” Conclusions: Adolescents know less about how methods of contraception work than they realize and this inaccurate information appears to influence their contraceptive decision making. Fully educating adolescents about contraceptives' known and unknown mechanisms of action may assist them in making more informed decisions about contraception.
P29 PRIMARY CARE PROVIDER'S PERSPECTIVES ON THE CHALLENGES OF CONTRACEPTIVE COUNSELING Akers AA University of Pittsburgh, Pittsburgh, USA Santucci A, Nikolajski CE, Gold MA, Schwarz B Objectives: To examine primary care provider's perspectives about contraceptive counseling. Methods: Between November 2007 and January 2008, we conducted six focus groups with primary care providers (PCP) who work at four clinics in Pittsburgh, PA. The question guide explored whether, when and how providers provide contraception counseling. All groups were audio recorded, transcribed and coded by two independent coders using Atlas. Ti software. We used a grounded theory approach to content analysis. Results: Four contraceptive counseling styles were identified: (a) counseling as part of routine care, (b) counseling in response to a patient request, (c) counseling precipitated by the prescription of noncontraceptive medications and (d) counseling limited to referral to a family planning specialist. Health system barriers to contraceptive counseling included limited clinical time, competing medical priorities, the increasing number of contraceptive options, the age and gender diversity of primary care populations and the lack of communication between PCPs and gynecologists. Provider barriers included lack of knowledge and comfort regarding contraceptive counseling. Patient barriers included religious beliefs, infrequent sexual activity, familiarity with a limited number of methods and patient desire for fertility despite medical contraindications to pregnancy. Conclusions: Primary care providers vary widely in their knowledgebase, perceived competence and comfort providing contraceptive counseling. Efforts to improve integration of contraceptive counseling in primary care settings are needed. P30 FEMALE ADOLESCENTS' KNOWLEDGE OF AND ATTITUDES TOWARD THE MECHANISMS OF ACTION OF CONTRACEPTION Rossiter B University of Pittsburgh, Pittsburgh, PA, USA Gold M, Whetstone H
P31 INTIMATE PARTNER VIOLENCE IN WOMEN RECEIVING GYNECOLOGIC AND ABORTION CARE Chavkin D University of Pennsylvania, Philadelphia, PA, USA Gee RE Objectives: To examine the relationship between the number of abortions and intimate partner violence (IPV). Methods: A total of 1493 women at Planned Parenthood in Philadelphia were surveyed; 485 women presenting for routine gynecologic care and 1008 women presenting for abortion care. Institutional review board approval was received from the University of Pennsylvania. The selfadministered survey instrument contained 32 questions regarding patient demographics, contraception use and knowledge, reproductive health knowledge and an IPV screening tool. Results: We found that multiparity is associated with an increase in IPV. Additional factors associated with IPV included partner willingness to use contraception (pb.001), living situation (p=.001), employment status (p=.018) and being able to afford contraception (p=.001). Conclusion: Our results suggest that overall parity, not number of abortions, is associated with an increase in IPV. Further studies will be needed to confirm our findings and to confirm the positive risk factors identified. We hope to use these results to design and implement IPV prevention programs in this population. P32 INTRAUTERINE DEVICE KNOWLEDGE, ATTITUDES AND EXPERIENCE AMONG SENIOR OBSTETRICS AND GYNECOLOGY RESIDENTS Cabiya M University of Illinois at Chicago, Chicago, IL, USA Cowett A, Harwood B Objectives: To describe senior obstetrics and gynecology residents' knowledge, experience and attitudes regarding IUD provision and to assess
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whether knowledge, experience and attitudes correlate with plans for IUD provision following residency. Methods: Participation in a nationwide electronic survey was requested via email. The survey contained 23 questions regarding demographics, knowledge, experience with IUD insertion, attitudes toward IUD use and plans for provision in future practice. T test and chi-square test were used to compare continuous variables and categorical variables, respectively. Results: A total of 195 residents responded. Sixty percent of respondents answered at least seven of eight knowledge questions correctly. Residents' reported varied experience with IUD insertion during residency: no insertions, 2.6%; 1–20 insertions, 44.6%; 21–50 insertions, 40.5%; 51– 100 insertions, 10.3%. A total of 87.2% of residents described feeling very confident to insert an IUD without supervision. Greater than 95% exhibited a positive attitude toward IUD provision while 10% expressed concern that prescribing the IUD may lead to legal action against them. A total of 96.4% of respondents reported planning to prescribe and insert IUDs following residency. Conclusions: While insertion experience among the survey respondents was varied, residents demonstrated an overall proficiency in factual knowledge of the IUD as a highly effective and safe form of contraception. Respondents demonstrated a positive attitude toward the IUD, and the intention to prescribe and insert in future practice was strong. Further analysis will evaluate the relationship between demographic factors and IUD experience, attitudes and knowledgebase. P33 ADEQUACY OF TRAINING FOR FIRST-TIME USERS OF THE LEVONORGESTREL-RELEASING INTRAUTERINE SYSTEM IN THE UNITED STATES Costales A Bayer Health Care Pharmaceuticals, Wayne, NJ, USA Ferrante D, Uddin MA Objectives: To evaluate the adequacy of training for first-time users of the levonorgestrel-releasing intrauterine system (LNG IUS). Methods: A standardized hands-on training utilizing the product's “Insertion Instructions” was provided to 51 clinicians prior to the launch of the LNG IUS in the USA. In an open, noncomparative trial, the adequacy of training was evaluated based on the number of successful placements (defined as “fundal placement without complications”) and clarity/utility of training materials. Current experience with the LNG IUS was compared with the clinicians' previous successful placement of other intrauterine devices (IUDs). Results: Insertion was successful in 488 (96%) of 509 first attempts (intentto-treat population) and was rated as “easy” in 467 (92%). In a scale between 1 (totally disagree) and 7 (totally agree), 88% felt comfortable with the procedure and 92% concurred that the insertion instructions were clear and useful (scores from 5 to 7). About half of the investigators placed N10 IUDs in the 12 months prior to the study. There was no statistically significant correlation between the investigators' previous experience with the Cu IUD and the percentage of successful placements (r=0.03600; p=.80199). No perforations occurred. Conclusion: A standardized hands-on training utilizing the label's “Insertion Instructions” proved adequate for first-time users in the USA to achieve successful intrauterine placement of the LNG IUS, without placement-related complications. P34 ADOLESCENT PREGNANCY INTENTIONS AND LIKELIHOOD: A LONGITUDINAL ANALYSIS OF LATINO GIRLS AND BOYS
Rocca C University of California, Berkeley, Berkeley, CA, USA Minnis A Objectives: To describe pregnancy intentions using multiple measures and examine which measures best predict pregnancy in a cohort of Latino males and females in San Francisco. Methods: We interviewed 555 adolescents, aged 15–19 years, over 2 years about pregnancy desire, partner intentions and pregnancy likelihood in the next 6 months. Pregnancies were assessed using urine pregnancy tests and self-report. We compared males and females on each intention measure and used multilevel logistic regression to identify which measures best predicted subsequent pregnancy. Results: Both girls and boys reported no pregnancy desire at 86% of visits. One-fifth of respondents who did not desire pregnancy reported that their partners wanted a pregnancy. Almost one-quarter (23%) of females showed no desire yet some likelihood of pregnancy. Males showed even a greater difference, with 40% expressing no desire yet some likelihood. The best predictor of pregnancy for girls was a combined measure of any pregnancy desire and perceived partner desire (OR=4.4 compared to those with no desire or likelihood). For boys, a combined measure of any desire for pregnancy and any likelihood of pregnancy was the best predictor (OR=7.2). Conclusions: In this cohort, boys and girls viewed pregnancy and pregnancy risk differently, suggesting the need for tailored measures. Results highlight the importance of using multiple measures of pregnancy intention to predict pregnancy. Results can inform the development of valid prospective measures of pregnancy intentions and improvement of clinical assessments for pregnancy prevention.
P35 HOW ARE WE TRAINING OBSTETRIC AND GYNECOLOGY RESIDENTS IN FAMILY PLANNING? Guiahi M Loyola University, Maywood, IL, USA Trester M, Heraty S, Lukens M, Summers S, Hruska L, Kenton K Objectives: To assess whether residents' perception of family planning (FP) training varies in faith-based (FBP) vs. non–faith-based training programs (NFBP). Methods: We are distributing written surveys to 395 residents at 20 accredited Midwest Obstetric and Gynecology programs from February through April 2008. Seven programs are FBPs. Residents self-assess their skills in counseling and performing FP procedures as recommended by CREOG and Ryan Foundation. We compared residents' responses by residency type using chi-square test of association. Results: We report preliminary data from the first wave of surveys collected from nine programs (88 surveys). Five of these programs are FBPs. Regarding satisfaction with FP training: 62% — satisfied; 31% — somewhat satisfied; 5% — unsatisfied. The majority (≥90%) stated they could counsel patients regarding hormonal contraception, natural FP, barrier methods, spermicide and permanent sterilization. Less than 80% of residents stated they could independently perform the following: placement of a diaphragm or cervical cap, insertion and removal of implantable steroidal contraception, hysteroscopic sterilization, or dilation and evacuation (D&E). Residents in NFBP feel better prepared to counsel about laparoscopic and hysteroscopic sterilization (p=.04, p=.002) and D&E (p=.04); prescribe postcoital contraception (p=.03); and perform laparoscopic and hysteroscopic sterilization (p=.01, p=.001), cervical dilation including laminaria (p=.008), vacuum aspiration (p=.001) and D&E (p=.001).
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Objectives: With the exact mechanisms of action of hormonal contraception still unknown and with evidence both for and against postfertilization effects, it is important to assess how influential postfertilization effects are to female adolescents' choice of contraception. Methods: We conducted 30-min face-to-face interviews with 196 female adolescents, aged 13 to 21 years, from an outpatient adolescent clinic to determine what they know about the mechanisms of action of various methods of contraception and what their attitudes are regarding different mechanisms of action. Results: Participants had a knowledge level of 8.49±3.68 (range 0–20) for the mechanism of actions of various methods. Although the majority of participants could not categorize accurately the 18 different contraceptive's mechanism of action, there was a correlation between the method's mechanism and the method participants intended to use. Over half (59.2%) said that their choice to stop or continue using a method depended on how often the method works after fertilization but before implantation with 39.3% saying they would “definitely not use something to prevent pregnancy that works after implantation.” Conclusions: Adolescents know less about how methods of contraception work than they realize and this inaccurate information appears to influence their contraceptive decision making. Fully educating adolescents about contraceptives' known and unknown mechanisms of action may assist them in making more informed decisions about contraception.
P29 PRIMARY CARE PROVIDER'S PERSPECTIVES ON THE CHALLENGES OF CONTRACEPTIVE COUNSELING Akers AA University of Pittsburgh, Pittsburgh, USA Santucci A, Nikolajski CE, Gold MA, Schwarz B Objectives: To examine primary care provider's perspectives about contraceptive counseling. Methods: Between November 2007 and January 2008, we conducted six focus groups with primary care providers (PCP) who work at four clinics in Pittsburgh, PA. The question guide explored whether, when and how providers provide contraception counseling. All groups were audio recorded, transcribed and coded by two independent coders using Atlas. Ti software. We used a grounded theory approach to content analysis. Results: Four contraceptive counseling styles were identified: (a) counseling as part of routine care, (b) counseling in response to a patient request, (c) counseling precipitated by the prescription of noncontraceptive medications and (d) counseling limited to referral to a family planning specialist. Health system barriers to contraceptive counseling included limited clinical time, competing medical priorities, the increasing number of contraceptive options, the age and gender diversity of primary care populations and the lack of communication between PCPs and gynecologists. Provider barriers included lack of knowledge and comfort regarding contraceptive counseling. Patient barriers included religious beliefs, infrequent sexual activity, familiarity with a limited number of methods and patient desire for fertility despite medical contraindications to pregnancy. Conclusions: Primary care providers vary widely in their knowledgebase, perceived competence and comfort providing contraceptive counseling. Efforts to improve integration of contraceptive counseling in primary care settings are needed. P30 FEMALE ADOLESCENTS' KNOWLEDGE OF AND ATTITUDES TOWARD THE MECHANISMS OF ACTION OF CONTRACEPTION Rossiter B University of Pittsburgh, Pittsburgh, PA, USA Gold M, Whetstone H
P31 INTIMATE PARTNER VIOLENCE IN WOMEN RECEIVING GYNECOLOGIC AND ABORTION CARE Chavkin D University of Pennsylvania, Philadelphia, PA, USA Gee RE Objectives: To examine the relationship between the number of abortions and intimate partner violence (IPV). Methods: A total of 1493 women at Planned Parenthood in Philadelphia were surveyed; 485 women presenting for routine gynecologic care and 1008 women presenting for abortion care. Institutional review board approval was received from the University of Pennsylvania. The selfadministered survey instrument contained 32 questions regarding patient demographics, contraception use and knowledge, reproductive health knowledge and an IPV screening tool. Results: We found that multiparity is associated with an increase in IPV. Additional factors associated with IPV included partner willingness to use contraception (pb.001), living situation (p=.001), employment status (p=.018) and being able to afford contraception (p=.001). Conclusion: Our results suggest that overall parity, not number of abortions, is associated with an increase in IPV. Further studies will be needed to confirm our findings and to confirm the positive risk factors identified. We hope to use these results to design and implement IPV prevention programs in this population. P32 INTRAUTERINE DEVICE KNOWLEDGE, ATTITUDES AND EXPERIENCE AMONG SENIOR OBSTETRICS AND GYNECOLOGY RESIDENTS Cabiya M University of Illinois at Chicago, Chicago, IL, USA Cowett A, Harwood B Objectives: To describe senior obstetrics and gynecology residents' knowledge, experience and attitudes regarding IUD provision and to assess
180
Abstracts / Contraception 78 (2008) 167–195
whether knowledge, experience and attitudes correlate with plans for IUD provision following residency. Methods: Participation in a nationwide electronic survey was requested via email. The survey contained 23 questions regarding demographics, knowledge, experience with IUD insertion, attitudes toward IUD use and plans for provision in future practice. T test and chi-square test were used to compare continuous variables and categorical variables, respectively. Results: A total of 195 residents responded. Sixty percent of respondents answered at least seven of eight knowledge questions correctly. Residents' reported varied experience with IUD insertion during residency: no insertions, 2.6%; 1–20 insertions, 44.6%; 21–50 insertions, 40.5%; 51– 100 insertions, 10.3%. A total of 87.2% of residents described feeling very confident to insert an IUD without supervision. Greater than 95% exhibited a positive attitude toward IUD provision while 10% expressed concern that prescribing the IUD may lead to legal action against them. A total of 96.4% of respondents reported planning to prescribe and insert IUDs following residency. Conclusions: While insertion experience among the survey respondents was varied, residents demonstrated an overall proficiency in factual knowledge of the IUD as a highly effective and safe form of contraception. Respondents demonstrated a positive attitude toward the IUD, and the intention to prescribe and insert in future practice was strong. Further analysis will evaluate the relationship between demographic factors and IUD experience, attitudes and knowledgebase. P33 ADEQUACY OF TRAINING FOR FIRST-TIME USERS OF THE LEVONORGESTREL-RELEASING INTRAUTERINE SYSTEM IN THE UNITED STATES Costales A Bayer Health Care Pharmaceuticals, Wayne, NJ, USA Ferrante D, Uddin MA Objectives: To evaluate the adequacy of training for first-time users of the levonorgestrel-releasing intrauterine system (LNG IUS). Methods: A standardized hands-on training utilizing the product's “Insertion Instructions” was provided to 51 clinicians prior to the launch of the LNG IUS in the USA. In an open, noncomparative trial, the adequacy of training was evaluated based on the number of successful placements (defined as “fundal placement without complications”) and clarity/utility of training materials. Current experience with the LNG IUS was compared with the clinicians' previous successful placement of other intrauterine devices (IUDs). Results: Insertion was successful in 488 (96%) of 509 first attempts (intentto-treat population) and was rated as “easy” in 467 (92%). In a scale between 1 (totally disagree) and 7 (totally agree), 88% felt comfortable with the procedure and 92% concurred that the insertion instructions were clear and useful (scores from 5 to 7). About half of the investigators placed N10 IUDs in the 12 months prior to the study. There was no statistically significant correlation between the investigators' previous experience with the Cu IUD and the percentage of successful placements (r=0.03600; p=.80199). No perforations occurred. Conclusion: A standardized hands-on training utilizing the label's “Insertion Instructions” proved adequate for first-time users in the USA to achieve successful intrauterine placement of the LNG IUS, without placement-related complications. P34 ADOLESCENT PREGNANCY INTENTIONS AND LIKELIHOOD: A LONGITUDINAL ANALYSIS OF LATINO GIRLS AND BOYS
Rocca C University of California, Berkeley, Berkeley, CA, USA Minnis A Objectives: To describe pregnancy intentions using multiple measures and examine which measures best predict pregnancy in a cohort of Latino males and females in San Francisco. Methods: We interviewed 555 adolescents, aged 15–19 years, over 2 years about pregnancy desire, partner intentions and pregnancy likelihood in the next 6 months. Pregnancies were assessed using urine pregnancy tests and self-report. We compared males and females on each intention measure and used multilevel logistic regression to identify which measures best predicted subsequent pregnancy. Results: Both girls and boys reported no pregnancy desire at 86% of visits. One-fifth of respondents who did not desire pregnancy reported that their partners wanted a pregnancy. Almost one-quarter (23%) of females showed no desire yet some likelihood of pregnancy. Males showed even a greater difference, with 40% expressing no desire yet some likelihood. The best predictor of pregnancy for girls was a combined measure of any pregnancy desire and perceived partner desire (OR=4.4 compared to those with no desire or likelihood). For boys, a combined measure of any desire for pregnancy and any likelihood of pregnancy was the best predictor (OR=7.2). Conclusions: In this cohort, boys and girls viewed pregnancy and pregnancy risk differently, suggesting the need for tailored measures. Results highlight the importance of using multiple measures of pregnancy intention to predict pregnancy. Results can inform the development of valid prospective measures of pregnancy intentions and improvement of clinical assessments for pregnancy prevention.
P35 HOW ARE WE TRAINING OBSTETRIC AND GYNECOLOGY RESIDENTS IN FAMILY PLANNING? Guiahi M Loyola University, Maywood, IL, USA Trester M, Heraty S, Lukens M, Summers S, Hruska L, Kenton K Objectives: To assess whether residents' perception of family planning (FP) training varies in faith-based (FBP) vs. non–faith-based training programs (NFBP). Methods: We are distributing written surveys to 395 residents at 20 accredited Midwest Obstetric and Gynecology programs from February through April 2008. Seven programs are FBPs. Residents self-assess their skills in counseling and performing FP procedures as recommended by CREOG and Ryan Foundation. We compared residents' responses by residency type using chi-square test of association. Results: We report preliminary data from the first wave of surveys collected from nine programs (88 surveys). Five of these programs are FBPs. Regarding satisfaction with FP training: 62% — satisfied; 31% — somewhat satisfied; 5% — unsatisfied. The majority (≥90%) stated they could counsel patients regarding hormonal contraception, natural FP, barrier methods, spermicide and permanent sterilization. Less than 80% of residents stated they could independently perform the following: placement of a diaphragm or cervical cap, insertion and removal of implantable steroidal contraception, hysteroscopic sterilization, or dilation and evacuation (D&E). Residents in NFBP feel better prepared to counsel about laparoscopic and hysteroscopic sterilization (p=.04, p=.002) and D&E (p=.04); prescribe postcoital contraception (p=.03); and perform laparoscopic and hysteroscopic sterilization (p=.01, p=.001), cervical dilation including laminaria (p=.008), vacuum aspiration (p=.001) and D&E (p=.001).