Provider self-disclosure during contraceptive counseling

Evaluating Provider Self-Disclosure in Adolescent Contraception Counseling

STUDY OBJECTIVE

This study aimed to assess the prevalence of provider self-disclosure (PSD) of intrauterine device (IUD) usage with adolescent patients and identify the content and context of their PSD.

DESIGN AND SETTING

A cross-sectional study PARTICIPANTS: Providers sex-assigned female at birth who counsel adolescents or young adults on contraception INTERVENTION: Participants were asked to voluntarily complete a web-based survey disseminated through the North American Society for Pediatric and Adolescent Gynecology listserve.

MAIN OUTCOME MEASURES

PSD in relation to IUD use (IUD-PSD) and other contraception use RESULTS: Eighty-five respondents completed the survey. Thirty-one (36%) reported that PSD of contraception usage to adolescents is usually or always appropriate, 32 (38%) as neither appropriate nor inappropriate, and 22 (26%) as usually or always inappropriate. Regarding IUDs, 61 respondents have used or are currently using an IUD. Forty-four (72%) IUD users have self-disclosed IUD use to an adolescent by choice, 6 (10%) have only by patient request, and 9 (15%) have never self-disclosed use. Out of 52 IUD users, 32 (62%) stated that IUD-PSD most often occurs when the patient has decided on the IUD but has questions, 25 (48%) when the patient was debating between fewer methods, and 14 (27%) when discussing all contraceptive options with the patient. Respondents who choose to self-disclose IUD use are more likely to disclose other contraceptive use compared with those who do not self-disclose IUD use (P < 0.001) and are also more likely to disclose personal family aspects (P < 0.001).

CONCLUSION

Self-disclosure of IUD usage is relatively common among study respondents and occurs most often after a patient has decided on an IUD.

Health workers' values and preferences regarding contraceptive methods globally: A systematic review

OBJECTIVE

We sought to systematically review the literature on health workers' values and preferences related to contraceptive methods.

STUDY DESIGN

As part of a larger review, we searched ten electronic databases for published articles from January 1, 2005 through July 27, 2020. We included studies that reported qualitative or quantitative data from the perspective of health workers providing family planning services globally.

RESULTS

Forty-one studies met our inclusion criteria. These studies included 12,643 health workers and were conducted in 27 countries. Health worker values and preferences for contraceptive methods were affected by factors related to contraceptive method characteristics (e.g., bleeding pattern and convenience), the contraceptive user (e.g., medical history, parity), and the health worker themselves (e.g., training, environment). Differences were also noted between various professions/specialties (e.g., comfort level with contraceptive methods, depth of experience). While contraceptive counseling and provision were influenced by health worker values and preferences, they were also affected by health worker misconceptions and biases.

CONCLUSION

Health worker values and preferences for contraception are affected by the client's history, medical eligibility, and the health worker context. Provision of contraception that is affected by harmful bias towards certain populations or about certain methods can negatively affect patient-centered care. Future work should address knowledge gaps and health worker biases by improving and standardizing education and training globally, to ensure high-quality, rights-based, and patient-centered contraceptive services.

Provider Practices and Young Women's Experiences with Provider Self-disclosure during Emergency Contraceptive Visits

BACKGROUND

Research on the impact of providers disclosing personal contraceptive experiences with patients is limited. In this study, we examine patient and provider perspectives about provider self-disclosure (PSD) of personal contraceptive experiences and its effects on contraceptive decision making and the provider-patient relationship.

METHODS

We conducted 18 one-on-one telephone interviews with clinicians who provide contraceptive services to young women and 17 patients seeking emergency contraception from three Bay Area community-based, youth-friendly clinics regarding their contraceptive counseling practices and experiences, respectively. After transcribing and coding all interviews, we summarized structural codes related to contraceptive counseling and PSD.

RESULTS

Although providers noted that PSD could help to build rapport and increase patient comfort, most did not report self-disclosing their contraceptive experiences, primarily owing to concerns that it might cross professional boundaries or compromise patient autonomy. All patients held positive attitudes toward and welcomed PSD practices, with many noting that it increased their comfort and trust in their provider.

CONCLUSIONS

There were notable differences between patient and provider attitudes toward PSD of contraceptive method use, with patients expressing more positive feelings about the practice than providers. Community-based providers should consider that many young women welcome self-disclosure of provider contraceptive experiences and that more research is needed to understand the effects of PSD practices around contraception on the patient-provider relationship and autonomous contraceptive decision making.