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Sütcüoğlu BM, Güler M. Social Media Videos on Contraceptive Implants: An Assessment of Video Quality and Reliability. J Pediatr Adolesc Gynecol 2024; 37:39-44. [PMID: 37634871 DOI: 10.1016/j.jpag.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
STUDY OBJECTIVE There are many videos on contraception on YouTube and TikTok, and women around the world use video platforms extensively to seek health information from videos of uncertain reliability and quality. The main objective of this research was to evaluate the scientific reliability and quality of the most popular social media videos about contraceptive subdermal implants. METHODS TikTok and YouTube videos were assessed separately by two gynecologists. The video quality was evaluated according to the DISCERN score, modified DISCERN score, and Global Quality Scale (GQS) score. RESULTS The study included the 100 most popular videos, 44 of which were uploaded by health care professionals. The median DISCERN score for videos shared by health care professionals was 50 (range 15-75), whereas it was 22 (range 15-56) for videos shared by independent users (P < .001). The median modified DISCERN score was 4 (min-max 0-5), and the median GQS score was 4 (min-max 1-5) for the videos uploaded by health care professionals. The modified DISCERN and GQS scores of TikTok videos were lower than those of YouTube videos (both P < .001). CONCLUSION Social media videos about contraceptive subdermal implants are popular and have been viewed tens of thousands of times, but the overall medical validity, which we evaluated according to the scoring systems, was poor. Despite the large number of videos, the content's quality and reliability are quite limited. There is a need to prioritize the education provided to patients by gynecologists, as well as to create high-quality content for YouTube and other similar platforms.
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Affiliation(s)
| | - Melike Güler
- Lokman Hekim University, Department of Obstetrics and Gynaecology, Ankara, Turkey
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2
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Lin CJ, Maier J, Nwankwo C, Burley C, deBorja L, Aaraj YA, Lewis E, Rhem M, Nowalk MP, South-Paul J. Awareness and Use of Contraceptive Methods and Perceptions of Long-Acting Reversible Contraception Among White and Non-White Women. J Womens Health (Larchmt) 2020; 30:1313-1320. [PMID: 33297819 DOI: 10.1089/jwh.2020.8642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Unintended pregnancies continue to account for half of all pregnancies in the United States, primarily due to incorrect or inconsistent use of contraception methods. Long-acting reversible contraception (LARC) methods are safe and highly effective, yet underutilized. Low uptake of LARC may be due to inadequate education, misconceptions, and cultural factors such as race, ethnicity, or religion. This study examined racial differences in contraceptive awareness and use among women seeking care at family health centers. Materials and Methods: Focus groups were used to identify recurrent themes in contraceptive choice of participants and develop a survey, completed by nonpregnant female patients 18-45 years of age from seven family health centers. Results: Among a total of 465 participants, 210 (46.2%) of whom were non-white, awareness of most types of birth control was generally high. Awareness of all types of contraceptives was significantly higher among white than non-white women (p < 0.001). Across most types of contraceptives, use was significantly higher among white women than non-white women with the exception of injectable hormones which were used significantly more often by non-white women (46.0% vs. 28.5%; p < 0.001). Reasons for using LARC did not vary by type nor by race but reasons for not using LARC varied by race and by specific method. Conclusions: Differing patterns of awareness, use, and perceptions of contraceptive methods between white and non-white women were revealed. By understanding factors that influence contraceptive awareness, use, and perceptions, clinicians can better address the contraceptive needs and concerns of their female patients. Clinical Trial # NCT03486743.
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Affiliation(s)
- Chyongchiou J Lin
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - John Maier
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Chidinma Nwankwo
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Cassie Burley
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Leyan deBorja
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yassmin Al Aaraj
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Lewis
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marla Rhem
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mary Patricia Nowalk
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jeannette South-Paul
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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3
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Marra E, Meijer S, de Graaf H. Changes in young women’s contraceptive use in the Netherlands: findings from three sex under the age of 25 surveys. GENUS 2020. [DOI: 10.1186/s41118-020-00078-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractPrevention of unintended pregnancy among adolescents and young adults under 25 years is pivotal from an individual as well as societal perspective. In the USA, the use of long-acting reversible contraceptive (LARC) has been shown to increase, with no or little change in the use of short-acting reversible contraceptive (SARC). We assessed trends in no contraceptive, SARC, and LARC use by young women, aged between 12 and 25 years, and differences in trends within demographic groups (age, religion, ethnic background, and educational level) among these young women in the Netherlands. Data of sexually active young women aged 12–25 years from three cross-sectional representative surveys, 2005, 2012, and 2017, were used for this study. In total, 11,229 Dutch young women were included with a median age of 20 years (interquartile range 18–23 years). Overall, the proportion of young women using SARC decreased significantly between 2005 and 2017 from 88 to 76%. LARC use increased significantly between 2005 and 2017 from 3 to 16%. These trends varied by religious groups and educational level, emphasizing potential for tailored preventative measures for these groups. A shift towards LARC use might eventually lead to a further decrease in unwanted pregnancy and potentially abortion because of the lower risk of user errors.
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Callahan DG, Garabedian LF, Harney KF, DiVasta AD. Will it Hurt? The Intrauterine Device Insertion Experience and Long-Term Acceptability Among Adolescents and Young Women. J Pediatr Adolesc Gynecol 2019; 32:615-621. [PMID: 31401254 DOI: 10.1016/j.jpag.2019.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/15/2019] [Accepted: 08/05/2019] [Indexed: 01/18/2023]
Abstract
STUDY OBJECTIVE To examine how the intrauterine device (IUD) insertion experience affects long-term IUD acceptability among adolescents. DESIGN Text to Web survey study. SETTING Boston Children's Hospital and Cambridge Health Alliance in Massachusetts. PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES Nulliparous adolescents aged 13-21 years who received an IUD or etonogestrel implant between January 2012 and May 2018. RESULTS We received survey responses from 95 adolescents (n = 46 IUD; n = 49 implant; response rate = 95/1098 (9%)). Mean current age (20.8 years) and time since device insertion (2.4 years) were similar between groups. Although a large proportion of both groups (64%) experienced moderate to severe preprocedural anxiety, IUD users expected more insertional pain compared with implant users (55.6 vs 39.6; P = .01). Compared with implant users, more IUD users experienced moderate to severe insertional pain (80% vs 18%; P < .0001), recalled that the procedure hurt more than expected (52% vs 4%; P < .0001), and endorsed lower rates of pain management satisfaction (72.4 vs 85.6; P = .04). Most respondents would recommend their method to a friend (75%) or consider getting the same device in the future (63%). When explicitly asked, more IUD users reported that dislike of the insertion procedure might or would probably prevent them from getting the same device in the future (41% vs 14%; P = .005). CONCLUSION Compared with implant users, IUD users reported more negative insertion experiences, although preprocedural anxiety was prevalent in both groups. Dislike of the insertion experience might negatively affect adolescents' willingness to continue using an IUD in the future. Findings should encourage multimodal interventions to holistically improve the IUD insertion experience.
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Affiliation(s)
- Dana G Callahan
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Laura F Garabedian
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Kathleen F Harney
- Department of Obstetrics and Gynecology, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Amy D DiVasta
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
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5
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Lefkowitz ES, Vasilenko SA, Wesche R, Maggs JL. Changes in Diverse Sexual and Contraceptive Behaviors Across College. JOURNAL OF SEX RESEARCH 2019; 56:965-976. [PMID: 30071171 PMCID: PMC6411451 DOI: 10.1080/00224499.2018.1499854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Researchers have made repeated calls for a better understanding of normative sexuality development during adolescence and young adulthood. We examined how the occurrence of seven penetrative, nonpenetrative, and contraceptive behaviors changed longitudinally across seven waves, and how individual (gender) and contextual (romantic relationship status) factors related to these changes in a sample of college students (N = 730, M age = 18.4 at Semester 1; 51% female; 26% Hispanic/Latino American, 22% Black/African American, 30% Asian American/Pacific Islander, 45% White/European American). Across college, reported kissing, touching, performing and receiving oral sex, and penetrative sex rates increased, and contraception use (any type) and condom use (in particular) rates decreased, demonstrating changes with age independent of young adults' romantic relationship experiences. Rates of all sexual behaviors were higher, and of contraception use lower, when students were in serious romantic relationships. Contraception use decreased more for men than for women, particularly in semesters men were not in serious relationships. Condom use decreased for men, and for women in semesters they were in serious relationships. Findings demonstrate normative trends in sexuality development, as well as suggesting the value of enhanced sexual health promotion programming, with a particular focus on contraceptive behaviors, across college.
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Affiliation(s)
- Eva S. Lefkowitz
- Department of Human Development and Family Studies, University of Connecticut, 348 Mansfield Rd., Unit 1058, Storrs, CT 06269-1058, USA, , Phone: 860-486-6420
| | - Sara A. Vasilenko
- The Methodology Center, Pennsylvania State University, University Park, PA 16802
| | - Rose Wesche
- Center for AIDS Intervention Research, Department of Psychology and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer L. Maggs
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA 16802
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6
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Smith AJB, Hurwitz AG, Singh T, Harney KF. Pediatric Provider Education and Use of Long-Acting Reversible Contraception in Adolescents. J Pediatr Health Care 2019; 33:146-152.e1. [PMID: 30228031 DOI: 10.1016/j.pedhc.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/03/2018] [Accepted: 07/15/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Pediatric primary care providers prescribe the majority of contraception to adolescents, but they often lack training in long-acting reversible contraception (LARC). Our objective was to assess whether a provider education initiative was associated with a change in LARC use for adolescents. METHOD Using electronic medical records, we examined LARC use for 7,331 women ages 15 to 21 years with an established primary care provider before and after a provider education initiative on LARC. We used an interrupted time series design to examine trends in LARC use related to the intervention. RESULTS Before the intervention, 3.4% to 3.8% of adolescents were using a LARC method, and LARC use was declining by 4 devices/10,000 adolescents per month (95% confidence interval = [-5, -2] per 10,000 adolescents). After the intervention, LARC use stabilized. The number of adolescents using a LARC method increased nonsignificantly at 3, 6, 9, and 12 months after the intervention. DISCUSSION Education of pediatric primary care providers reversed a trend toward decreased use of long-acting reversible contraception.
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7
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Walsh-Buhi ER, Helmy HL. Trends in long-acting reversible contraceptive (LARC) use, LARC use predictors, and dual-method use among a national sample of college women. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:225-236. [PMID: 29111911 DOI: 10.1080/07448481.2017.1399397] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Assess long-acting reversible contraceptive (LARC) and other contraceptive use trends, identify LARC use predictors, and examine dual method use. PARTICIPANTS Women in the American College Health Association-National College Health Assessment (ACHA-NCHA) II, aged 18-24 years, who reported having vaginal sex (N = 37,899). METHODS Secondary analyses of Fall 2011-2014 ACHA-NCHA II data. RESULTS Statistically significant increases in LARC usage and, specifically, implant usage, were found. Characteristics associated with LARC use included age, race/ethnicity, relationship status, and school type. Students reporting LARC use had lower odds of condom usage compared with non-LARC hormonal method users. CONCLUSION This analysis of LARC predictors and dual LARC/condom use has implications for research and health promotion efforts. Findings suggest that college health services are well positioned to meet the sexual and reproductive health needs of diverse populations of students. College health professionals should elicit students' individual and/or relationship priorities to tailor messaging/services offered for pregnancy/STI prevention.
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Affiliation(s)
- Eric R Walsh-Buhi
- a Division of Health Promotion and Behavioral Science , Graduate School of Public Health, San Diego State University , San Diego , California , USA
| | - Hannah L Helmy
- b Department of Public Health , Montclair State University , Montclair , New Jersey , USA
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8
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Parra Ribes I, Rascón Poza JJ, Pérez Campos E, Bugella Yudice I, Rodríguez Domingo MJ. Economic Burden of Contraception Management in Spain. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2018; 6:63-74. [PMID: 32685572 PMCID: PMC7309956 DOI: 10.36469/9785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND A wide variety of contraceptive methods are available, some of them reimbursed by the Spanish National Health System (SNHS). However, the number of unintended pregnancies (UP) is still significant, leading to a high economic burden, mainly derived from non-adherence to and the incorrect use of contraceptive methods. OBJECTIVES This study aims to estimate the economic burden associated with reversible contraception management in Spain, from the perspectives of both the SNHS and women, over a 5-year period. METHODS A survey was performed to identify contraception management in Spain based on the experience of a panel of six expert gynecologists. An economic model was conducted to quantify the current burden of contraception according to healthcare resources use over 5 years. The costs included in the analysis were diagnostic tests, initial and follow-up consultations, methods acquisition costs, and UP derived from therapy failure. RESULTS Reversible contraception costs in Spain amount to €12.5 billion over a 5-year period. Condoms and combined oral contraceptives (COC) account for 86.8% of the total cost and the other methods only 13.2%. There are differences in contraceptive use according to women's age. Short-acting reversible contraceptives (SARC) such as COC, condom and vaginal ring, are most commonly used by younger women. However, SARC are correlated with the highest failure rate, resulting in over €7.2 billion cost, explained by the high number of UP. Long-acting reversible contraceptives (LARC), such as the levonorgestrel-releasing intrauterine system (LNG-IUS20), implant and copper intrauterine devices (IUD), are selected by women over 35 years of age due to user-independent compliance. SARC methods result in a higher cost per woman over 5 years: vaginal ring €2427.8, patch €2402.6, condom €2060.1 and COC €1895.1; while LARC methods are the most economic option per women: LNG-IUS20 €630.4, copper IUD €658.2, LNG-IUS12 €703.8, intramuscular injectable €907.8 and implant €940.5. CONCLUSIONS LARC methods result in lower costs compared with SARC options from the perspectives of the SNHS and women, explained by user-independent compliance, preventing a significant number of UP and its elevated economic burden. An increased LARC methods use could avoid UP events, leading to significant cost-savings for the SNHS.
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9
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Smith AJB, Harney KF, Singh T, Hurwitz AG. Provider and Health System Factors Associated with Usage of Long-Acting Reversible Contraception in Adolescents. J Pediatr Adolesc Gynecol 2017; 30:609-614. [PMID: 28502827 DOI: 10.1016/j.jpag.2017.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE Long-acting reversible contraception (LARC) is recommended as first-line contraception for adolescents. Surveys of primary care providers suggest that physician and clinic factors might influence LARC counseling, but their effect on usage is unknown. Our objective was to explore provider and clinic characteristics associated with LARC usage in adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a cross-sectional study of 5363 women ages 15-21 years receiving primary care within a large health system in Massachusetts in 2015. We used data abstracted from electronic medical records to characterize rates of LARC usage. We analyzed the association of provider (specialty, degree, gender, resident status, LARC credentialing) and clinic (Title X funding, onsite LARC provision, onsite obstetrician-gynecologist) factors with adolescents' LARC usage using multivariate logistic regression. RESULTS Overall, 3.4% (95% confidence interval [CI], 2.9-3.9) of adolescents were documented as currently using a LARC method. Older adolescents were significantly more likely to use a LARC method (adjusted odds ratio, 2.41; 95% CI, 1.62-3.58 for women ages 20-21 years compared with ages 15-17 years). Adolescents whose primary care provider was a resident were significantly more likely to use a LARC method (adjusted odds ratio, 1.65; 95% CI, 1.02-2.68). Provider specialty, degree, gender, onsite LARC provision, and onsite obstetrician-gynecologist were not significantly associated with LARC usage in adolescents. CONCLUSION Being older and having a primary care provider early in their training increased the odds of LARC usage among adolescents in a large Massachusetts health system. Across primary care specialties, educating providers about the appropriate uses of LARC methods in nulliparous adolescents might facilitate LARC usage.
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Affiliation(s)
- Anna Jo Bodurtha Smith
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Kathleen F Harney
- Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Tara Singh
- Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Anita Gupta Hurwitz
- Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Cambridge Health Alliance, Cambridge, Massachusetts
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10
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Howard B, Grubb E, Lage MJ, Tang B. Trends in use of and complications from intrauterine contraceptive devices and tubal ligation or occlusion. Reprod Health 2017; 14:70. [PMID: 28595627 PMCID: PMC5465441 DOI: 10.1186/s12978-017-0334-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-acting reversible contraceptives such as intrauterine devices (IUDs) are highly effective in preventing pregnancy, cost effective, and increasing in popularity. It is unclear whether changes in IUD use are associated with changes in rates of irreversible tubal sterilization. In this analysis, we evaluate changes in rates of tubal sterilization, insertion of copper or levonorgestrel (LNG) IUDs, and related complications over time. METHODS Data were obtained from a retrospective claims database (OptumTM ClinformaticsTM Data Mart) of women aged 15 to 45 years who underwent insertion of copper or LNG IUD or tubal sterilization between 1/1/2006 and 12/31/2011. Outcomes of interest included annual rates of insertion or sterilization and annual rates of potential complications and side effects. RESULTS The number of women included in the analysis each year ranged from 1,870,675 to 2,016,916. Between 2006 and 2011, copper IUD insertion claim rates increased from 0.18 to 0.25% and LNG IUD insertion claim rates increased from 0.63 to 1.15%, while sterilization claims decreased from 0.78 to 0.66% (P < 0.0001 for all comparisons). Increases in IUD insertion were apparent in all age groups; decreases in tubal sterilization occurred in women aged 20 to 34 years. The most common side effects and complications were amenorrhea (7.36-11.59%), heavy menstrual bleeding (4.85-15.69%), and pelvic pain (11.12-14.27%). Significant increases in claims of certain complications associated with IUD insertion or sterilization were also observed. CONCLUSION Between 2006 and 2011, a decrease in sterilization rates accompanied an increase in IUD insertion rates, suggesting that increasing numbers of women opted for reversible methods of long-term contraception over permanent sterilization.
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Affiliation(s)
- Brandon Howard
- Teva Global Medical Affairs, 41 Moores Road, Frazer, PA, 19355, USA.
| | - ElizaBeth Grubb
- Teva Global Health Economics & Outcomes Research, 11100 Nall Ave, Overland Park, KS, 66211, USA
| | - Maureen J Lage
- HealthMetrics Outcomes Research, 27576 River Reach Dr., Bonita Springs, FL, 34134, USA
| | - Boxiong Tang
- Teva Global Health Economics & Outcomes Research, 41 Moores Road, Frazer, PA, 19355, USA
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11
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Lohr PA, Lyus R, Prager S. Use of intrauterine devices in nulliparous women. Contraception 2017; 95:529-537. [DOI: 10.1016/j.contraception.2016.08.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 08/23/2017] [Indexed: 02/07/2023]
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12
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Hopkins B. Barriers to Health Care Providers' Provision of Long-Acting Reversible Contraception to Adolescent and Nulliparous Young Women. Nurs Womens Health 2017; 21:122-128. [PMID: 28388997 DOI: 10.1016/j.nwh.2017.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/14/2016] [Indexed: 06/07/2023]
Abstract
Despite recommendations for long-acting reversible contraception (LARC) as a first-line contraceptive method for adolescents and young women, its use in the United States remains low. This integrative review highlights previously unidentified barriers to health care providers' provision of LARC to adolescent and nulliparous young women. Four themes emerged: Appropriateness of Candidates and Contraceptive Safety, Provider Training and Work Setting, Appropriate Resources, and Opportunity. Raising awareness of barriers to LARC use may galvanize providers to find solutions. Nurses and other clinicians can remain aware of new contraceptive options and guidelines to reduce the risk of unintended pregnancy among adolescents.
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13
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Paul J, Boraas CM, Duvet M, Chang JC. YouTube and the single-rod contraceptive implant: a content analysis. ACTA ACUST UNITED AC 2017; 43:195-200. [PMID: 28108504 DOI: 10.1136/jfprhc-2016-101593] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/18/2016] [Accepted: 12/21/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Since the internet has become an important source of contraceptive information with YouTube.com as the second most visited site, we analysed contraceptive implant YouTube videos for content and clinical accuracy. METHODS Using the terms 'contraceptive implant', 'Nexplanon' and 'Implanon', the top 20 results on YouTube by relevance and view count were identified. After excluding duplicates, single-rod implant videos in English were included. Videos were classified as providing a professional or patient perspective. Views, duration and comments were noted. Videos were rated for reliability, global quality scale and whether they were positive or negative about the implant. Inter-rater agreement was measured. RESULTS A total of 120 videos were retrieved; 52 were eligible for review. Less than 23% were professional videos; the majority reported patient experience (46% testimonials, 27% real-time procedure videos, 4% other). Patient videos had been posted a significantly longer duration of time than professional videos (364 vs 188 days, p=0.02), were less reliable (p≤0.0001) and were of lower global quality (p<0.0001). Some 61% of implant testimonial videos were rated as 'positive experiences' and inter-rater agreement was very good (κ=0.81). All testimonials mentioned side effects, commonly irregular bleeding and discomfort with insertion. A minority (26%) reported misinformation. CONCLUSIONS This study found that most of the information on YouTube pertaining to contraceptive implants is accurate, is presented from the patient's perspective, and promotes the method's use.
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Affiliation(s)
- Jennifer Paul
- Kaiser Permanente, Greater Baltimore Medical Center, 7141 Security Boulevard, Baltimore, MD, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christy M Boraas
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Mildred Duvet
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Obstetrics and Gynecology, Leigh Valley Health Network, Allentown, PA, USA
| | - Judy C Chang
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Magee-Womens Research Institute, Pittsburgh, PA, USA.,Center for Research in Health Care/Center for Women's Health Research and Innovation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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14
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Kumar N, Brown JD. Access Barriers to Long-Acting Reversible Contraceptives for Adolescents. J Adolesc Health 2016; 59:248-253. [PMID: 27247239 DOI: 10.1016/j.jadohealth.2016.03.039] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/28/2016] [Accepted: 03/28/2016] [Indexed: 01/08/2023]
Abstract
The United States continues to have the highest adolescent birth rate of any industrialized country. Recently published guidelines by the American Academy of Pediatrics create a new consensus among professional organizations around the suitability of long-acting reversible contraceptives as first-line contraception for adolescents. Through a narrative review of U.S. studies published after 2000, this study seeks to summarize existing access barriers to long-acting reversible contraceptives for adolescents and highlight areas that warrant further intervention so that the recommendations of these professional organizations can be effectively integrated into clinical practice. Existing barriers include costs for institutions providing contraceptive care and for recipients; consent and confidentiality for adolescent patients; providers' attitudes, misconceptions and limited training; and patients' lack of awareness or misconceptions. Systemic policy interventions are required to address cost and confidentiality, such as the Affordable Care Act's mandate that contraceptive coverage be a part of essential health benefits for all insurance providers. Individual-level access barriers such as providers' misconceptions and gaps in technical training as well as patients' lack of awareness can be addressed directly by professional medical organizations, health care training programs, and other interventions.
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Affiliation(s)
- Natasha Kumar
- Warren Alpert Medical School of Brown University, Providence Rhode Island.
| | - Joanna D Brown
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Hall KS, Ela E, Zochowski MK, Caldwell A, Moniz M, McAndrew L, Steel M, Challa S, Dalton VK, Ernst S. "I don't know enough to feel comfortable using them:" Women's knowledge of and perceived barriers to long-acting reversible contraceptives on a college campus. Contraception 2016; 93:556-64. [PMID: 26879627 PMCID: PMC4853253 DOI: 10.1016/j.contraception.2016.02.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 02/06/2016] [Accepted: 02/10/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess multiple dimensions of long-acting reversible contraception (LARC) knowledge and perceived multi-level barriers to LARC use among a sample of college women. STUDY DESIGN We conducted an Internet-based study of 1982 female undergraduates at a large mid-western university. Our 55-item survey used a multi-level framework to measure young women's understanding of, experiences with intrauterine devices (IUD) and implants and their perceived barriers to LARC at individual, health systems and community levels. The survey included a 20-item knowledge scale. We estimated and compared LARC knowledge scores and barriers using descriptive, bivariate and linear regression statistics. RESULTS Few college women had used (5%) or heard of (22%) LARC, and most self-reported "little" or "no" knowledge of IUDs (79%) and implants (88%). Women answered 50% of LARC knowledge items correctly (mean 10.4, range 0-20), and scores differed across sociodemographic groups (p values<.04). Factors associated with scores in multivariable models included race/ethnicity, program year, sorority participation, religious affiliation and service attendance, employment status, sexual orientation and contraceptive history. Perceived barriers to IUDs included the following: not wanting a foreign object in body (44%), not knowing enough about the method (42%), preferring a "controllable" method (42%), cost (27%), and not being in a long-term relationship (23%). Implant results were similar. "Not knowing enough" was women's primary reason for IUD (18%) and implant (22%) nonuse. CONCLUSION Lack of knowledge (both perceived and actual) was the most common barrier among many perceived individual-, systems- and community-level factors precluding these college women's LARC use. Findings can inform innovative, multi-level interventions to improve understanding, acceptability and uptake of LARC on campuses. IMPLICATIONS Lack of knowledge of IUDs and implants served as a primary barrier to highly effective contraceptive use among these college women. Comprehensive, patient-centered and multi-level educational public health strategies are needed to promote positive campus climates around LARC and improve family planning outcomes among this substantial reproductive-aged population.
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Affiliation(s)
- Kelli Stidham Hall
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, GCR 560, Atlanta, GA 30322, USA.
| | - Elizabeth Ela
- Population Studies Center, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Melissa K Zochowski
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Amy Caldwell
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
| | - Michelle Moniz
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Laura McAndrew
- University Health Service, University of Michigan, Ann Arbor, MI, USA
| | - Monique Steel
- University Health Service, University of Michigan, Ann Arbor, MI, USA
| | - Sneha Challa
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Vanessa K Dalton
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Susan Ernst
- University Health Service, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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Hillard PJA. Intrauterine Device Use in Adolescents. J Adolesc Health 2015; 57:359-60. [PMID: 26403839 DOI: 10.1016/j.jadohealth.2015.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Paula J Adams Hillard
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
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Berenson AB, Tan A, Hirth JM. Complications and continuation rates associated with 2 types of long-acting contraception. Am J Obstet Gynecol 2015; 212:761.e1-8. [PMID: 25555662 DOI: 10.1016/j.ajog.2014.12.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/23/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We sought to compare complication and continuation rates of the levonorgestrel intrauterine system (LNG-IUS) with the subdermal etonogestrel (ENG) implant across the United States among girls and women 15-44 years of age. STUDY DESIGN A retrospective study of health insurance claims records from 2007 through 2011 identified a cohort of women who had LNG-IUS (n = 79,920) or ENG implants (n = 7374) inserted and had insurance coverage for 12 months postinsertion. Claims for complications were examined 12 months after insertion, or until removal of either device within each of 3 age groups. RESULTS After its introduction in 2007, the frequency of ENG implants increased each year and almost a third of all insertions were in teenagers. However, among women ≤24 years old who had delivered an infant in the prior 8 weeks, a LNG-IUS was more likely to be inserted than an ENG implant (P < .05). The most frequent complications with both methods were related to abnormal menstruation, which was more likely to occur among ENG implant users. Overall, 83-88% of the entire sample used their chosen method for at least 12 months. The odds of continuation were similar for both methods among teenagers, but ENG implants were more likely to be removed prematurely among women 20-24 years old (odds ratio, 1.21; 95% confidence interval, 1.06-1.39) and 25-44 years old (odds ratio, 1.49; 95% confidence interval, 1.35-1.64). CONCLUSION Both of these long-acting contraceptive methods are well tolerated among women of all ages, and demonstrate high continuation rates.
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Abstract
Oral contraception (OC) remains a popular noninvasive, readily reversible approach for pregnancy prevention and, largely off label, for control of acne, hirsutism, dysmenorrhea, irregular menstruation, menorrhagia, and other menstrual-related symptoms. Many OC formulations exist, with generics offering lower cost and comparable efficacy. Certain medical conditions, including hypertension, migraine, breast cancer, and risk of venous thromboembolism (VTE), present contraindications. Blood pressure measurement is the only physical examination or testing needed before prescription. Although no OC is clearly superior to others, OCs containing the second-generation progestin levonorgestrel have been associated with lower VTE risk than those containing other progestins.
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Affiliation(s)
- Ginger Evans
- VA Puget Sound Health Care System, 1660 South Columbian Way, S-123-PCC, Seattle, WA 98108, USA.
| | - Eliza L Sutton
- Women's Health Care Center, University of Washington, 4245 Roosevelt Way Northeast, Box 354765, Seattle, WA 98105, USA
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20
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Pazol K, Whiteman MK, Folger SG, Kourtis AP, Marchbanks PA, Jamieson DJ. Sporadic contraceptive use and nonuse: age-specific prevalence and associated factors. Am J Obstet Gynecol 2015; 212:324.e1-8. [PMID: 25305406 PMCID: PMC4346406 DOI: 10.1016/j.ajog.2014.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/19/2014] [Accepted: 10/06/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to characterize age-group specific patterns in the stability of contraceptive use and to evaluate whether factors that are associated with nonuse and sporadic use, compared with stable use, differ by age among women who are at risk for unintended pregnancy. STUDY DESIGN We used data from the 2006-2010 National Survey of Family Growth to characterize the prevalence of stable and sporadic contraceptive use and nonuse by age over a 1-year period. We used polytomous logistic regression models to assess the odds of contraceptive nonuse and sporadic use vs stable use. Age-stratified models were used to show age-group differences in associated characteristics. RESULTS Over a 1-year period, stable contraceptive use decreased across age groups from 80% for teens 15-19 years old to 74% for women 20-24 years old, and 70-71% for women 25-34 and 35-44 years old. Contraceptive nonuse increased across age groups from 5% for teens 15-19 years old to 9-20% for older women. By contrast, sporadic use was least common for women 35-44 years old (10% compared with 16-17% for younger women). Among teens 15-19 years old, a history of method discontinuation because of dissatisfaction was associated with nonuse. Among older women, intentions to have children in the future and reported difficulty achieving pregnancy were associated with nonuse and sporadic use. CONCLUSION Because the stability of contraceptive use and associated factors differ by age, providers may need to consider these differences when talking to women about contraception. To address nonuse, helping teens identify a method that they are comfortable using may be especially important; for older women, discussing the potential for continuing fertility may be more important. To address sporadic use, discussing the benefits of user-independent methods may be helpful, with a particular emphasis on long-acting reversible contraceptives for younger women and teens who are less likely to have completed their desired childbearing and who have tended to rely on methods that are more difficult to use consistently.
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Affiliation(s)
- Karen Pazol
- Women's Health and Fertility Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Maura K Whiteman
- Women's Health and Fertility Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Suzanne G Folger
- Women's Health and Fertility Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Athena P Kourtis
- Women's Health and Fertility Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Polly A Marchbanks
- Women's Health and Fertility Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Denise J Jamieson
- Women's Health and Fertility Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Gilliam ML, Martins SL, Bartlett E, Mistretta SQ, Holl JL. Development and testing of an iOS waiting room "app" for contraceptive counseling in a Title X family planning clinic. Am J Obstet Gynecol 2014; 211:481.e1-8. [PMID: 24881829 DOI: 10.1016/j.ajog.2014.05.034] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 04/25/2014] [Accepted: 05/24/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Long-acting reversible contraceptive (LARC) methods, such as the intrauterine device and implant, are highly effective but used by less than 10% of US women. The objective of our study was to improve LARC interest by enhancing clinic counseling. STUDY DESIGN A quality improvement methodology was used to evaluate intrauterine device service delivery in 3 Chicago Title X clinics. To address identified barriers, we developed a theory-based iOS application (app) for patients to use in the clinic waiting room using human-centered design. The final prototype was tested in a randomized controlled trial in a Title X clinic with sexually active females (79% African American) under age 30 years. Our sample of 60 was chosen to detect an increase from 10% (baseline) to 45% (app intervention) in the proportion of patients expressing interest in discussing a LARC method during their clinic visit with 80% power and two-sided α = 0.05. After completing demographic and baseline knowledge questionnaires, participants were randomized 1:1 to intervention (app) or standard care arms. App users also completed a posttest. Our primary outcome was expressed interest in discussing a LARC method during the clinic visit. Secondary outcomes were contraceptive knowledge and LARC selection. RESULTS App testers (n = 17) preferred interactive, visually appealing design and video testimonials. In the pilot randomized controlled trial (n = 52), app users had a significantly higher knowledge of contraceptive effectiveness (P = .0001) and increased interest in the implant (7.1-32.1%, P = .02) after the intervention. Users were highly satisfied with the app. Staff reported no problems using the app in the clinic. CONCLUSION Use of a theory-based counseling app offers a novel method to optimize wait time while minimizing clinic flow disruption. Preliminary data demonstrate that app use was associated with improvements in patients' contraceptive knowledge and interest in the implant.
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Affiliation(s)
- Melissa L Gilliam
- Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL.
| | - Summer L Martins
- Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Emily Bartlett
- Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Stephanie Q Mistretta
- Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Jane L Holl
- Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Yoost J. Understanding benefits and addressing misperceptions and barriers to intrauterine device access among populations in the United States. Patient Prefer Adherence 2014; 8:947-57. [PMID: 25050062 PMCID: PMC4090129 DOI: 10.2147/ppa.s45710] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Three intrauterine devices (IUDs), one copper and two containing the progestin levonorgestrel, are available for use in the United States. IUDs offer higher rates of contraceptive efficacy than nonlong-acting methods, and several studies have demonstrated higher satisfaction rates and continuation rates of any birth control method. This efficacy is not affected by age or parity. The safety of IUDs is well studied, and the risks of pelvic inflammatory disease, perforation, expulsion, and ectopic pregnancy are all of very low incidence. Noncontraceptive benefits include decreased menstrual blood loss, improved dysmenorrhea, improved pelvic pain associated with endometriosis, and protection of the endometrium from hyperplasia. The use of IUDs is accepted in patients with multiple medical problems who may have contraindications to other birth control methods. Yet despite well-published data, concerns and misperceptions still persist, especially among younger populations and nulliparous women. Medical governing bodies advocate for use of IUDs in these populations, as safety and efficacy is unchanged, and IUDs have been shown to decrease unintended pregnancies. Dispersion of accurate information among patients and practitioners is needed to further increase the acceptability and use of IUDs.
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Affiliation(s)
- Jennie Yoost
- Marshall University Department of Obstetrics and Gynecology, Huntington, WV, USA
- Correspondence: Jennie Yoost, Marshall University Department of Obstetrics and Gynecology, 1600 Medical Center Drive Suite 4500, Huntington, WV 25701, USA, Tel +1 304 691 1460, Fax +1 304 691 1453, Email
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