Perspectives toward contraceptive counseling among women with complex medical co-morbidities: A Mixed-Methods Study

Abstract

This study was undertaken to examine contraceptive counseling practices among pregnant women with complex medical co-morbidities, and to elucidate patient attitudes and perceptions about contraceptive counseling using a mixed methods approach. We conducted 28 semi-structured interviews with pregnant women with pre-existing medical co-morbidities to examine factors influencing contraceptive counseling. Interview questions focused on patient attitudes about contraception in the setting of medical co-morbidities, contraceptive access, preferred approach to counseling, and their ideal contraceptive. Development of the interview guide and coding were guided by the Theory of Planned Behavior. Interview transcripts were coded and analyzed using Dedoose® software with deductive and inductive content analysis. Data pertaining to maternal demographics, medical history, contraceptive use, and pregnancy outcomes were obtained through participant surveys and from electronic health records. Out of 33 eligible women approached over a 7-month duration, 30 were recruited and 28 completed interviews. The majority of participants were Black, between the ages of 16 – 45 years, and had several complex medical co-morbidities. Overarching themes included: 1) Contraceptive misinformation 2) Counseling content material 3) Delivering counseling 4) Failure of birth control and 5) Perceptions about the ideal contraceptive. Notably, patients voiced the desire for counseling to be goal oriented and patient centered rather than provider driven. Participants provided valuable insights into the sources of contraceptive information, misinformation, and the preferred approach for delivering counseling - including the timing, style and clinical setting. Our research has identified several opportunities for enhancing the contraceptive counseling experience for pregnant women with complex medical co-morbidities. Insights from patient perspectives lay the groundwork for designing interventions that promote effective contraception in a cohort at high risk for adverse perinatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)