Urban Adolescents' and Young Adults' Decision-Making Process around Selection of Intrauterine Contraception

• Published in: Journal of pediatric & adolescent gynecology Vol. 29; no. 3; pp. 234 - 239
• Main Authors: Rubin, Susan E., MD, MPH, Felsher, Marisa, MPH, Korich, Faye, BA, Jacobs, Amanda M., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2016
• Subjects: Adolescent; Adult; Caregivers; Choice Behavior; Contraception; Contraception - methods; Contraception - psychology; Contraception decision-making; Counseling; Decision Making; Family Planning Services; Female; Grounded Theory; Humans; Intrauterine devices; Intrauterine Devices - statistics & numerical data; New York; Obstetrics and Gynecology; Pediatrics; Qualitative Research; Reproductive health; Urban Population; Young Adult; Decision-making; Qualitative research; Reproductive health; Adolescent; Contraception decision-making; Counseling; Female; Contraception; Intrauterine devices
• ISSN: 1083-3188; 1873-4332
• DOI: 10.1016/j.jpag.2015.09.001

Abstract Study Objective To examine adolescent and young adults' priorities, values, and preferences affecting the choice to use an intrauterine contraceptive device (IUD). Design Qualitative exploratory study with analysis done using a modified grounded theory approach. Setting Outpatient adolescent medicine clinic located within an academic children's hospital in the Bronx, New York. Participants Twenty-seven women aged 16 to 25 years of age on the day of their IUD insertion. Interventions and Main Outcome Measures We conducted semistructured interviews exploring participant's decision making process around selecting an IUD. We were specifically interested in elucidating factors that could potentially improve IUD counseling. Results We identified 4 broad factors affecting choice: (1) personal; (2) IUD device-specific; (3) health care provider; and (4) social network. Most of the participants perceived an ease with a user-independent method and were attracted by the high efficacy of IUDs, potential longevity of use, and the option to remove the device before its expiration. Participants described their health care provider as being the most influential individual during the IUD decision-making process via provision of reliable, accurate contraceptive information and demonstration of an actual device. Of all people in their social network, mothers played the biggest role. Conclusion Adolescents and young women who choose an IUD appear to value the IUDs' efficacy and convenience, their relationship with and elements of clinicians' contraceptive counseling, and their mother's support. Our results suggest that during IUD counseling, clinicians should discuss these device-specific benefits, elicit patient questions and concerns, and use visual aids including the device itself. Incorporating the factors we found most salient into routine IUD counseling might increase the number of adolescents and young women who choose an IUD as a good fit for them.