Counseling About IUDs: A Mixed‐Methods Analysis

Abstract

CONTEXT IUDs are infrequently used in the United States. Assessing how counseling about this method is delivered can help identify barriers to IUD use that might be overcome by improving services. METHODS A sample of 342 family planning visits at six clinics in the San Francisco Bay Area in 2009–2012 were audio-recorded, and patients completed surveys both before and after their visits. Descriptive quantitative analyses of counseling were performed, and correlates of IUDs’ being mentioned during counseling were investigated using logistic regression. Qualitative analyses investigated the counseling women received about IUDs generally (in a subset of 42 visits), as well as counseling for women who already had an IUD in place (13 visits) or who felt their provider inappropriately expressed a preference for IUDs (five visits). RESULTS IUDs were mentioned in 75% of visits. Patient-initiated mention of IUDs was more likely in visits by women aged 35 or older than in those by women younger than 20 (odds ratio, 6.4); provider-initiated discussion of this method was less common if the provider was older than 55 than if he or she was younger than 46 (0.3). Providers more often discussed potential adverse effects of IUD use than benefits; counseling often was noninteractive and did not address how patient preferences related to characteristics of IUDs. Counseling was frequently fragmented by the need for return visits or referral elsewhere for insertion. CONCLUSIONS IUD counseling may be improved by enhancing comprehensiveness and patient-centeredness, and by decreasing fragmentation of care.

Contraceptive Counseling

“…With respect to relational communication, these have documented that, across settings, the interaction is often provider-dominated, with minimal engagement between women and their providers in the process of method selection 20,26,27 and with frequent failure of providers to deliver personalized counseling tailored to the individual women's needs and preferences. 27-29,30 Similarly, providers inconsistently engage in such task-oriented communication as providing information about side effects or how to use a method correctly. For example, one study documented that 37% of women choosing the hormonal IUD were not informed of the likelihood of irregular bleeding with this method, 30 and in a study of counseling about oral contraceptive pills 26% of women were not given any information about what to do if they forget a pill.…”

“…27-29,30 Similarly, providers inconsistently engage in such task-oriented communication as providing information about side effects or how to use a method correctly. For example, one study documented that 37% of women choosing the hormonal IUD were not informed of the likelihood of irregular bleeding with this method, 30 and in a study of counseling about oral contraceptive pills 26% of women were not given any information about what to do if they forget a pill. 29 …”

Patient-Centered Contraceptive Counseling: Evidence to Inform Practice

“…Several analyses of a study utilizing audio-recorded patient visits indicate some incongruity between what the evidence suggests women want from counseling and what occurs in practice. An analysis of counseling specifically about IUDs found that this was usually non-interactive and did not incorporate how patient preferences related to IUD characteristics [34]. More generally, a qualitative analysis of counseling approaches found that providers infrequently engaged with patients around their preferences, with less than one quarter of patients experiencing shared decision making in which there was interactive communication around method selection [35•].…”

A checklist approach to caring for women seeking pregnancy testing: Effects on contraceptive knowledge and use

“…(17) However, for many women, the fragmentation of care which is produced when counseling is followed by referral to another clinic for desired contraceptive placement can be problematic. (18) For this reason, an important aspect of the intervention we studied was the offer of same-day initiation of any desired contraceptive, especially if the woman was interested in an IUD or subdermal implant.…”