The role of narratives in patient-provider discussions about contraceptive decisions

Abstract

Rationale, aims and objectives: Use of contraception is essential for reducing rates of unintended pregnancy. Understanding how women acquire knowledge and develop beliefs about contraception can help providers improve person-centered contraceptive counseling and provision. In addition, investigating providers’ perspectives and strategies for contraceptive counseling may help identify strengths and weaknesses of counseling approaches. This paper explores personal and social narratives about contraception and how these narratives impact healthcare encounters and patients’ decisions.Methods: Qualitative data were collected as part of a larger study aimed at implementing a model for patient-centered contraceptive provision in community health centers. Sixty participants (13 patients between the ages of 14-45 and 47 staff and providers) were recruited from 3 Federally Qualified Health Centers to participate in semi-structured interviews. Data were contextualized according to a taxonomy of narratives to support decision-making.Results: Patients often learned about contraception through narratives told by social connections. Both patients and health center staff and providers identified narratives as important influences on women’s selection of contraceptive methods. These narratives sometimes caused women to be wary of specific methods. Patients primarily related outcome-based (as opposed to process- or experience-oriented) narratives. Staff and providers recognized the power of narratives, although they were sometimes frustrated by patients’ reliance on these narratives. Providers described a number of strategies for engaging with patients’ narratives during counseling sessions.Conclusions: Our findings underscore the strong influence of narratives on women’s selection of contraceptive methods. Health narratives are a potential strategy to facilitate informed decision-making about contraception in clinical encounters and educational campaigns.