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Provision of long-acting reversible contraceptive methods by pediatricians
376
ABSTRACTS / Contraception 92 (2015) 359–414
Results: Many pediatricians reported poor or outdated knowledge about LARC methods and did not recommend them to adolescents. While some pediatricians were advocates for LARC methods, many others had concerns that they were inappropriate for adolescents. Participants were afraid that IUD use could result in pelvic inflammatory disease among young women at high risk for STIs. Pediatricians described adolescents' concerns about having devices in their bodies, although implants were believed to be more acceptable than IUDs to patients. Generally, participants favored the implant over the IUD for adolescents. Importantly, LARC methods do not appear to be “on the radar” for pediatricians, patients or their parents and were rarely discussed. Outcomes: With insufficient knowledge about the risks and benefits of LARC methods and infrequent opportunities to provide them on-site, providers' routine counseling focused on familiar and readily available methods (the injectable and oral contraceptives). Until pediatricians' uncertainties about tolerability and safety of IUDs are addressed, they may remain reluctant advocates for LARC methods. Pediatricians may need counseling scripts and educational aids about these methods. http://dx.doi.org/10.1016/j.contraception.2015.06.092
P43 Provision of long-acting reversible contraceptive methods by pediatricians Norris A Ohio State University, Columbus, OH, USA Pritt N, Berlan E Objectives: In the United States, half of high school students have had sex; extremely few use highly effective and safe long-acting reversible contraceptive (LARC) methods. Barriers to LARC method use among adolescent women include high costs, method unavailability and lack of knowledge. Pediatricians are key health providers for most adolescents, yet few offer LARC methods. Our objective was to identify barriers to and opportunities for LARC method provision by pediatricians. Methods: During June–August 2014, we conducted interviews with 23 pediatricians in a midwestern city to understand participants' views about contraception for adolescents, related confidentiality and privacy issues and contraceptive provision at participants' practices. To analyze the data, our team developed a coding schema and conducted a priori and open coding of transcripts. Results: Pediatricians were motivated to provide adolescent patients with high-quality care and to prevent unwanted pregnancies. However, most pediatric offices are not set up for gynecologic exams, and few pediatricians were trained to place IUDs or implants, necessitating referral for any adolescent to access LARC methods. Many pediatricians rarely initiated counseling for LARC method referral and believed that patients did not know about these methods. This resulted in low patient demand for LARC methods and no push to change provision practices. Outcomes: Pediatricians and their patients want to prevent pregnancy, but current norms do not support provision of LARC methods by pediatricians. To increase adolescents' access to LARC methods in pediatrician offices, training for pediatricians, modifications to improve referral systems or allow on-site LARC method placements and creation of demand among adolescents are recommended.
http://dx.doi.org/10.1016/j.contraception.2015.06.093
P44 Do the know-it-alls actually know? Comparing perceived and assessed knowledge of sexual and reproductive health among US adults Norris A Ohio State University, Columbus, OH, USA Bessett D, Esber A, Littman L, Serpico J, Kavanaugh M
Objectives: Knowledge about sexual and reproductive health (SRH) is not widely or equally distributed in the United States. We sought to understand relationships between individuals' perceptions of their SRH knowledge and their assessed knowledge. Methods: In August 2012, we administered an online questionnaire to a randomly selected sample of 995 men and women aged 18 or older in the United States. Perceived knowledge was self-reported for SRH overall and separately pregnancy/birth, contraception, abortion and infertility. Assessed knowledge was measured via participants' responses to objective questions across several SRH domains. Using multivariate logistic regression, we evaluated the relationship between perceived and assessed knowledge for each domain, adjusting for gender, personal experience, education and race/ethnicity. Results: Most participants (83%) perceived their overall SRH knowledge to be excellent or good. Participants who perceived higher SRH knowledge had statistically significantly higher levels of assessed knowledge. However, that difference is relative: those who thought they had excellent/good knowledge had a mean correct score of 41%, while those who considered their knowledge to be fair/poor had a mean correct score of 35%. In both the abortion and contraception domains, participants with perceived excellent/good knowledge had higher assessed knowledge (aOR, 2.01; 95% CI, 1.35–2.98 and aOR, 4.32; 95% CI, 1.96–9.50, respectively). There was no significant relationship between perceived and assessed knowledge on pregnancy/birth or infertility. Outcomes: Perceived knowledge is related to assessed knowledge for abortion and contraception. However, health care providers and public health practitioners should assume low SRH knowledge because perception of knowledge exceeds assessed knowledge for many. http://dx.doi.org/10.1016/j.contraception.2015.06.094
P45 How might Canadian women talk about peri-coital contraception? Parniak S University of Ottawa, Ottawa, ON, Canada Foster AM Objectives: High rates of unintended pregnancy worldwide demonstrate a gap in available contraceptive methods. If developed as planned, the pericoital contraceptive pill will be an effective and intuitive method that could be taken before or after unprotected sexual intercourse. Yet successful uptake of a new technology relies on concise terminology and frameworks with which to discuss it. This study aimed to investigate how women talk about different available contraceptive methods; explore how these discourses influence the language and frameworks used to discuss pericoital contraceptives; and identify Canadian women's perceptions of and concerns about this potential contraceptive method. Methods: In 2014–2015, we conducted seven focus group discussions in seven locations across Canada to explore how Canadian women aged 18–45 talk about current contraceptive methods and how this language informs how they might discuss pericoital contraception. Results: Participants thought the pericoital contraceptive pill would be a valuable addition to current methods, particularly for those who have less frequent intercourse. However, they disliked the term “peri-coital” and invented several names they considered to be more resonant. Women identified safety, efficacy and framing as the most important issues that should be addressed if pericoital contraception were introduced. Outcomes: The pericoital contraceptive pill promises to be a valuable addition to current contraceptive options in Canada. Efforts to develop terminology that is clear and intuitive may help facilitate this pill's eventual introduction and appears warranted.
http://dx.doi.org/10.1016/j.contraception.2015.06.095
ABSTRACTS / Contraception 92 (2015) 359–414
Results: Many pediatricians reported poor or outdated knowledge about LARC methods and did not recommend them to adolescents. While some pediatricians were advocates for LARC methods, many others had concerns that they were inappropriate for adolescents. Participants were afraid that IUD use could result in pelvic inflammatory disease among young women at high risk for STIs. Pediatricians described adolescents' concerns about having devices in their bodies, although implants were believed to be more acceptable than IUDs to patients. Generally, participants favored the implant over the IUD for adolescents. Importantly, LARC methods do not appear to be “on the radar” for pediatricians, patients or their parents and were rarely discussed. Outcomes: With insufficient knowledge about the risks and benefits of LARC methods and infrequent opportunities to provide them on-site, providers' routine counseling focused on familiar and readily available methods (the injectable and oral contraceptives). Until pediatricians' uncertainties about tolerability and safety of IUDs are addressed, they may remain reluctant advocates for LARC methods. Pediatricians may need counseling scripts and educational aids about these methods. http://dx.doi.org/10.1016/j.contraception.2015.06.092
P43 Provision of long-acting reversible contraceptive methods by pediatricians Norris A Ohio State University, Columbus, OH, USA Pritt N, Berlan E Objectives: In the United States, half of high school students have had sex; extremely few use highly effective and safe long-acting reversible contraceptive (LARC) methods. Barriers to LARC method use among adolescent women include high costs, method unavailability and lack of knowledge. Pediatricians are key health providers for most adolescents, yet few offer LARC methods. Our objective was to identify barriers to and opportunities for LARC method provision by pediatricians. Methods: During June–August 2014, we conducted interviews with 23 pediatricians in a midwestern city to understand participants' views about contraception for adolescents, related confidentiality and privacy issues and contraceptive provision at participants' practices. To analyze the data, our team developed a coding schema and conducted a priori and open coding of transcripts. Results: Pediatricians were motivated to provide adolescent patients with high-quality care and to prevent unwanted pregnancies. However, most pediatric offices are not set up for gynecologic exams, and few pediatricians were trained to place IUDs or implants, necessitating referral for any adolescent to access LARC methods. Many pediatricians rarely initiated counseling for LARC method referral and believed that patients did not know about these methods. This resulted in low patient demand for LARC methods and no push to change provision practices. Outcomes: Pediatricians and their patients want to prevent pregnancy, but current norms do not support provision of LARC methods by pediatricians. To increase adolescents' access to LARC methods in pediatrician offices, training for pediatricians, modifications to improve referral systems or allow on-site LARC method placements and creation of demand among adolescents are recommended.
http://dx.doi.org/10.1016/j.contraception.2015.06.093
P44 Do the know-it-alls actually know? Comparing perceived and assessed knowledge of sexual and reproductive health among US adults Norris A Ohio State University, Columbus, OH, USA Bessett D, Esber A, Littman L, Serpico J, Kavanaugh M
Objectives: Knowledge about sexual and reproductive health (SRH) is not widely or equally distributed in the United States. We sought to understand relationships between individuals' perceptions of their SRH knowledge and their assessed knowledge. Methods: In August 2012, we administered an online questionnaire to a randomly selected sample of 995 men and women aged 18 or older in the United States. Perceived knowledge was self-reported for SRH overall and separately pregnancy/birth, contraception, abortion and infertility. Assessed knowledge was measured via participants' responses to objective questions across several SRH domains. Using multivariate logistic regression, we evaluated the relationship between perceived and assessed knowledge for each domain, adjusting for gender, personal experience, education and race/ethnicity. Results: Most participants (83%) perceived their overall SRH knowledge to be excellent or good. Participants who perceived higher SRH knowledge had statistically significantly higher levels of assessed knowledge. However, that difference is relative: those who thought they had excellent/good knowledge had a mean correct score of 41%, while those who considered their knowledge to be fair/poor had a mean correct score of 35%. In both the abortion and contraception domains, participants with perceived excellent/good knowledge had higher assessed knowledge (aOR, 2.01; 95% CI, 1.35–2.98 and aOR, 4.32; 95% CI, 1.96–9.50, respectively). There was no significant relationship between perceived and assessed knowledge on pregnancy/birth or infertility. Outcomes: Perceived knowledge is related to assessed knowledge for abortion and contraception. However, health care providers and public health practitioners should assume low SRH knowledge because perception of knowledge exceeds assessed knowledge for many. http://dx.doi.org/10.1016/j.contraception.2015.06.094
P45 How might Canadian women talk about peri-coital contraception? Parniak S University of Ottawa, Ottawa, ON, Canada Foster AM Objectives: High rates of unintended pregnancy worldwide demonstrate a gap in available contraceptive methods. If developed as planned, the pericoital contraceptive pill will be an effective and intuitive method that could be taken before or after unprotected sexual intercourse. Yet successful uptake of a new technology relies on concise terminology and frameworks with which to discuss it. This study aimed to investigate how women talk about different available contraceptive methods; explore how these discourses influence the language and frameworks used to discuss pericoital contraceptives; and identify Canadian women's perceptions of and concerns about this potential contraceptive method. Methods: In 2014–2015, we conducted seven focus group discussions in seven locations across Canada to explore how Canadian women aged 18–45 talk about current contraceptive methods and how this language informs how they might discuss pericoital contraception. Results: Participants thought the pericoital contraceptive pill would be a valuable addition to current methods, particularly for those who have less frequent intercourse. However, they disliked the term “peri-coital” and invented several names they considered to be more resonant. Women identified safety, efficacy and framing as the most important issues that should be addressed if pericoital contraception were introduced. Outcomes: The pericoital contraceptive pill promises to be a valuable addition to current contraceptive options in Canada. Efforts to develop terminology that is clear and intuitive may help facilitate this pill's eventual introduction and appears warranted.
http://dx.doi.org/10.1016/j.contraception.2015.06.095