“I Wouldn’t Be this Firm if I Didn’t Care”: Preventive clinical counseling for reproductive health

Abstract

Objective-This qualitative study of the health care clinicians serving women at heightened risk of sexually transmitted infections and unintended pregnancy was undertaken to explore concepts underlying reproductive health counseling messages in clinical encounters.Methods-In-depth interviews were conducted with 31 clinicians, including physicians and advanced practice clinicians serving primarily low-income patients in high-risk communities throughout the U.S.Results-Most of the clinicians describe their influence on patients and protective behaviors as derived from medical authority and the presentation of information. The use of a parental style of authority, particularly for young or vulnerable patients, and emotional appeals to evoke negative emotions, such as fear, were also used to motivate protective behaviors. Many clinicians highlighted the importance of empathy, and understanding the cultural and social context of health behaviors. A few clinicians described innovative efforts to empower women to protect themselves and exert more control in relationships.Conclusion-Some of the reproductive health counseling approaches described by clinicians are not consistent with leading health behavior change theories or patient-centered counseling. To improve counseling, these messages and concepts need to be evaluated for effectiveness, and possibly used to inform the development of novel theories for use in reproductive health counseling.

Doctors’ experience of the contraceptive consultation: a qualitative study in Australia

“…Consistent with the findings of Henderson et al, 23 the doctors recognised some tension between the shared approach—informing patients of options and allowing autonomous decision making—and the reality of clinical consultations which sometimes involved more directive counselling. Our findings suggest doctors in part encourage methods according to their own preferences and their understanding of the latest evidence in the field, and this can sometimes merge back into a paternalistic rather than a shared model of care.…”

Contraceptive Counseling

“…One study of clinicians serving high-risk communities throughout the United States found that many reported having an influence on patients’ decisions about contraception, including through the use of scare tactics and by drawing on authority derived from their professional expertise. 40 In contrast, a similar study, also using qualitative methods, of providers serving African American adolescents in community health centers in Chicago found that providers emphasized relationship building in their counseling. 41 …”

Research on embedded counselling: An emerging topic of potential importance for the future of counselling psychology

“…In interviews with physicians and nurses about the counselling strategies they used in conversations with patients around preventive sexual health consultations, Henderson, Raine, Schalet, Blum, and Harper (2011) found that these healthcare workers had evolved a combination of "parental" authority, empathic connection and innovative problem-solving, as a means of addressing the specific needs of their patient group. Other studies have also found that practitioners of embedded counselling have integrated existing counselling theories and approaches into idiosyncratic "situated working models" (see e.g.…”