The high rate of unintended pregnancy in the United States1 places a heavy burden on women, society and the health care system.2 One factor contributing to this high rate is the underuse and inconsistent use of contraceptives. Not only do 11% of women at risk of unintended pregnancy not use any contraceptive method,3 but 25% of women using a reversible method rely on condoms, a method with relatively low efficacy.4 In addition, female contraceptive users report high rates of discontinuation and incorrect use of their chosen method.5,6 Patient-provider communication during family planning visits is one influence on women’s contraceptive use. Health communication has been recognized as a marker of quality health care by the Institute of Medicine,7 and has been found to be correlated with patient outcomes, including patient satisfaction and medication adherence, across a range of health conditions.8,9 In family planning care, patient assessment of the quality of interpersonal aspects of care has been linked to contraceptive use and continuation.10–12 Despite this evidence of the importance of contraceptive counseling, little is known about what occurs during routine family planning counseling. Qualitative studies of U.S. women’s counseling experiences have found that women often report being dissatisfied with the counseling they receive,13 and that many are concerned that providers do not fully disclose the potential side effects of methods.14 Research that has directly documented the contraceptive counseling dynamic has been largely limited to studies in the developing world, and these studies have found that family planning counseling sessions are often dominated by the provider.15–18 Even when the patient is the one ultimately making the decision about which method to use, there is often minimal provider engagement with patients to determine their preferences and concerns about methods and how these issues relate to available options.19,20 Given the increasing recognition of the value of patient-centered care, in which there is a focus on patients’ preferences and experiences,21 interventions to enhance patient-provider engagement during contraceptive decision making could improve the counseling experience, which may positively influence contraceptive use.22 However, because it is unclear whether these findings are relevant in the United States, an investigation of contraceptive counseling would improve our understanding of the range of approaches used by U.S. family planning providers and potentially identify areas for improvement. Specifically, elucidating how providers guide conversations with women who are selecting a method could inform interventions to improve providers’ ability to assist women in choosing a method that they will be able to use correctly and consistently. This is of critical relevance, as previous counseling interventions in family planning have been largely unsuccessful.23,24 In this article, we report results of a qualitative analysis of audio recordings of contraceptive counseling visits at clinics in the San Francisco Bay Area that serve racially and ethnically diverse patient populations, and describe providers’ approaches to contraceptive counseling and patterns in their use.
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Just Published
Oct 11, 2024
David Aduragbemi Okunlola + 3
Open Access