New York City Department of Health and Mental Hygiene, Bureau of Maternal, Infant and Reproductive Health, New York City, New York, USA.
J Adolesc Health. 2012 Oct;51(4):319-24. doi: 10.1016/j.jadohealth.2011.12.024. Epub 2012 Mar 13.
The American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention recommend intrauterine devices (IUDs) as safe and highly effective contraceptives for adolescents. Nevertheless, many U.S. providers do not recommend or provide IUDs to adolescents-a population at high risk for unintended pregnancy. The purpose of this study was to identify barriers to IUD provision for adolescents.
A 36-item self-administered survey of knowledge and attitudes regarding IUDs was completed by 162 staff of New York City school-based health centers, including 69 clinicians (e.g., pediatricians and nurse practitioners) and 93 nonclinicians (e.g., social workers and health educators).
Half (55%) of all respondents would be likely to recommend an IUD to a patient under age 20 years. Respondents were less likely to recommend an IUD for patients with history of recent STD (31%), remote pelvic inflammatory disease (37%), and patients not in a monogamous relationship (38%). Whereas 77% of respondents indicated that IUDs are safe for adolescents, 18% of those respondents would be unlikely to recommend an IUD to a patient under age 20 years. While 86% of respondents knew that IUDs can be used in nulliparous women, 25% of those respondents would be unlikely to recommend an IUD to a patient who has never been pregnant. Additionally, 61% believed that counseling patients about IUDs would take more time than other methods.
Misinformation about risks associated with IUDs and beliefs about patient eligibility may present barriers to provision. Apparent contradictions between knowledge and likelihood to recommend IUDs warrant further study.
美国妇产科医师学会和疾病控制与预防中心建议将宫内节育器（IUD）作为安全且高效的青少年避孕方法。然而，许多美国医生并不建议或向青少年提供 IUD——这是一个意外怀孕风险很高的群体。本研究旨在确定为青少年提供 IUD 的障碍。
对纽约市学校健康中心的 162 名工作人员（包括 69 名临床医生[如儿科医生和护士从业者]和 93 名非临床医生[如社会工作者和健康教育者]）进行了一项关于 IUD 知识和态度的 36 项自我管理调查。
半数（55%）的受访者可能会向 20 岁以下的患者推荐 IUD。对于有近期性传播疾病史（31%）、既往盆腔炎病史（37%）和非一夫一妻关系的患者（38%），受访者不太可能推荐 IUD。尽管 77%的受访者表示 IUD 对青少年是安全的，但仍有 18%的受访者不太可能向 20 岁以下的患者推荐 IUD。虽然 86%的受访者知道 IUD 可用于未生育的妇女，但仍有 25%的受访者不太可能向从未怀孕的患者推荐 IUD。此外，61%的人认为向患者咨询 IUD 会比其他方法花费更多时间。
关于 IUD 相关风险的信息错误和对患者资格的看法可能会成为提供 IUD 的障碍。知识和推荐 IUD 的可能性之间明显存在矛盾，需要进一步研究。
