Shared negative experiences of long-acting reversible contraception and their influence on contraceptive decision-making: a multi-methods study

Abstract

ObjectivesWe explored how negative stories about long-acting reversible contraception (LARC) — defined as a firsthand negative experience with LARC shared directly with the study participant — were involved in participants’ decisions about whether to use LARC following abortion, and how counseling affected the influence of negative LARC stories on contraceptive choices. Study designWe performed a multi-methods study, embedded within a trial examining the impact of a theory-based counseling intervention on LARC uptake post-abortion. Participants completed a baseline survey to determine the influence of negative LARC stories. We subsequently invited respondents who reported having heard negative LARC stories to participate in a semi-structured qualitative interview. We analyzed quantitative data with univariate statistics. We analyzed qualitative data using thematic content analysis. ResultsAmong the 60 participants, 16 (27%) reported having heard negative LARC stories. Two of the 16 (13%) planned to initiate LARC prior to counseling, compared to 18 of 44 women (41%) who had not heard negative LARC stories (p=0.06). Prior to counseling, 69% of participants with negative LARC stories reported that these stories made them less likely to use LARC. In qualitative interviews with 9 women, we identified several key themes: (1) negative LARC stories deterred LARC use; (2) friends and family were valued informants; (3) potential side effects were important to LARC decision-making; and (4) positive and negative features of the counseling encounter influenced the effect of negative LARC stories. ConclusionsNegative LARC stories are common among women presenting for abortion at our institution and may influence patient uptake of these methods.ImplicationsThis study uses a multi-methods approach to examine the influence of negative stories about long-acting reversible contraception (LARC) on decision-making about LARC. These findings can help providers elicit patients’ needs in contraception counseling and generate hypotheses for future counseling research.