“It’s a very nuanced discussion with every woman”: Health care providers’ communication practices during contraceptive counseling for patients with substance use disorders

Charron, Elizabeth; Mayo, Rachel; Heavner-Sullivan, Smith F; Eichelberger, Kacey Y.; Dickes, Lori; Truong, Khoa; Rennert, Lior

doi:10.1016/j.contraception.2020.09.002

Cited by 16 publications

(26 citation statements)

References 44 publications

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“…These findings reveal the potential conflict between provider and patient values in contraception counseling, a phenomenon well described across stigmatized populations, and highlights the importance of patient-led counseling. [10,38,39] Our data reinforces grounding contraception counseling in an open and supportive narrative about reproductive goals, and empowering patients to use methods aligning with their pursuit of sustained recovery. Individualized contraceptive decision support may also include known interventions such as information on self-removal of IUDs and referrals for pre-operative anesthesia consultation to discuss non-opioid pain management, as well as novel strategies such as linking daily oral contraceptive pill use to daily medication for opioid use disorder administration, or non-patient dependent tracking of LARC removal dates.…”

Section: Discussionsupporting

confidence: 60%

“…These patients feel that they are risking their fertility given their potential inability to remember removal dates or present for care should a problem with their IUD arise. [10,33,34] Correspondingly, few participants in our study emphasized contraceptive efficacy as the sole consideration in their contraceptive decision-making. Yet directive counseling approaches focused on population-level goals of reducing unintended pregnancies among women with OUD are commonly structured around tiered-effectiveness counseling.…”

Section: Discussionmentioning

confidence: 85%

“…These include stigma when interacting with the healthcare system, barriers to integrating comprehensive contraception care into substance use treatment, provider bias, and contraceptive coercion. [6,[9][10][11]. Studies also indicate some women with SUD encounter cost and insurance coverage barriers.…”

Section: Introductionmentioning

confidence: 99%

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Contraceptive decision making among pregnancy-capable individuals with opioid use disorder at a tertiary care center in Massachusetts

et al. 2021

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 85%

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Contraceptive decision making among pregnancy-capable individuals with opioid use disorder at a tertiary care center in Massachusetts

et al. 2021

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“…Further, giving women this option may increase uptake by reducing the number of attempted removals and negative experiences with the product, especially when such negative experiences may be shared, which could potentially dampen enthusiasm for the product among peer groups. An oral trial may be possible, depending on availability of the drug in oral forms, and has been used in Phase III clinical trials (22,23). A short-term implant may be another option, though this would potentially require additional insertions/removals depending on whether a full "dose" was desired after the trial.…”

Section: Discussionmentioning

confidence: 99%

“…A short-term implant may be another option, though this would potentially require additional insertions/removals depending on whether a full "dose" was desired after the trial. In a follow up discrete choice experiment, we plan to investigate the option for biodegradable implant that could be removed during a short period of time, e.g., one month, in case safety issues arose or they changed their minds (22,23).…”

Section: Discussionmentioning

confidence: 99%

End-User Research in Support of Long-Acting Systemic Antiretroviral Delivery Systems: Insights from Qualitative Research with Providers and Target Users in South Africa

Brown¹,

Hanif

Little³

et al. 2022

Preprint

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Background While oral pre-exposure prophylaxis (PrEP) has been shown to reduce the risk of HIV, challenges such as adhering to a daily-dosing regimen and persistence have emerged as barriers for at-risks populations in South Africa. This qualitative research sought to investigate perceptions of and preferences for a long-acting, biodegradable implantable PrEP product designed to address these barriers. Methods To identify and understand motivators, barriers, and preferences for the PrEP implant, we conducted qualitative in-depth interviews (IDIs) among health care providers (HCP) and target end-users (young women, adolescent girls, and female sex workers) in urban and rural regions of Gauteng Province, South Africa. The IDIs focused on defining values, beliefs, habits, lifestyles, influencers, and information channels for potential PrEP implant end-users. Results We conducted 36 IDIs across health care providers and target end-user respondent segments. Respondents had generally positive reactions to the PrEP implant. Most end-users felt that some undesirable aspects of the implant (e.g., side effects, pain during insertion, potential scarring, and dissolvability) would be offset by having a highly effective, and long-lasting HIV prevention product. Although some HCPs believed the implantable PrEP would lead to increases in promiscuity and risky sexual behavior, most HCPs saw value in the PrEP implant’s long duration of protection and the likelihood of higher adherence relative to oral PrEP. Conclusions While further research is necessary, this qualitative study demonstrates demand for a biodegradable, long-acting implantable PrEP and suggests such a product would be accepted by end-users and HCPs in South Africa. This study indicates the need to develop more convenient, discreet, long-acting, and highly effective biomedical HIV prevention options for at-risk populations.

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Contraception and Healthcare Utilization by Reproductive-Age Women Who Use Drugs in Rural Communities: a Cross-Sectional Survey

Levander

Foot

Magnusson³

et al. 2022

J GEN INTERN MED

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Background Women who use drugs (WWUD) have low rates of contraceptive use and high rates of unintended pregnancy. Drug use is common among women in rural U.S. communities, with limited data on how they utilize reproductive, substance use disorder (SUD), and healthcare services. Objective We determined contraceptive use prevalence among WWUD in rural communities then compared estimates to women from similar rural areas. We investigated characteristics of those using contraceptives, and associations between contraceptive use and SUD treatment, healthcare utilization, and substance use. Design Rural Opioids Initiative (ROI) — cross-sectional survey using respondent-driven sampling (RDS) involving eight rural U.S. regions (January 2018–March 2020); National Survey on Family Growth (NSFG) — nationally-representative U.S. household reproductive health survey (2017–2019). Participants Women aged 18–49 with prior 30-day non-prescribed opioid and/or non-opioid injection drug use; fecundity determined by self-reported survey responses. Main Measures Unweighted and RDS-weighted prevalence estimates of medical/procedural contraceptive use; chi-squared tests and multi-level linear regressions to test associations. Key Results Of 855 women in the ROI, 36.8% (95% CI 33.7–40.1, unweighted) and 38.6% (95% CI 30.7–47.2, weighted) reported contraceptive use, compared to 66% of rural women in the NSFG sample. Among the ROI women, 27% had received prior 30-day SUD treatment via outpatient counseling or inpatient program and these women had increased odds of contraceptive use (aOR 1.50 [95% CI 1.08–2.06]). There was a positive association between contraception use and recent medications for opioid use disorder (aOR 1.34 [95% CI 0.95–1.88]) and prior 6-month primary care utilization (aOR 1.32 [95% CI 0.96–1.82]) that did not meet the threshold for statistical significance. Conclusion WWUD in rural areas reported low contraceptive use; those who recently received SUD treatment had greater odds of contraceptive use. Improvements are needed in expanding reproductive and preventive health within SUD treatment and primary care services in rural communities.

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“It’s a very nuanced discussion with every woman”: Health care providers’ communication practices during contraceptive counseling for patients with substance use disorders

Cited by 16 publications

References 44 publications

Contraceptive decision making among pregnancy-capable individuals with opioid use disorder at a tertiary care center in Massachusetts

Contraceptive decision making among pregnancy-capable individuals with opioid use disorder at a tertiary care center in Massachusetts

End-User Research in Support of Long-Acting Systemic Antiretroviral Delivery Systems: Insights from Qualitative Research with Providers and Target Users in South Africa

Contraception and Healthcare Utilization by Reproductive-Age Women Who Use Drugs in Rural Communities: a Cross-Sectional Survey

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