Minnis Alexandra M, Mavedzenge Sue Napierala, Luecke Ellen, Dehlendorf Christine
Women's Global Health Imperative at RTI International, Research Triangle Park, NC; School of Public Health, University of California, Berkeley.
Perspect Sex Reprod Health. 2014 Dec;46(4):223-31. doi: 10.1363/46e1414. Epub 2014 May 1.
Contraceptive nonuse and misuse contribute to rates of unintended pregnancy and STDs among young women in the United States. Clinical providers assume an important role in guiding youths' contraceptive method choices.
Sixty-seven women aged 16-21 were recruited as part of a cohort study, conducted in 2009-2012, that examined provider-patient interactions during family planning visits at six San Francisco clinics. Interactions between patients and providers were audio-recorded. Participants completed questionnaires about method preference immediately before seeing the provider; they reported on method choice immediately after the visit and by telephone three and six months later. Transcripts were analyzed to examine providers' strategies for guiding decision making and addressing youths' contraceptive concerns. Missed opportunities for promoting young women's reproductive health were identified.
Twenty-one percent of young women who did not report desiring a hormonal or long-acting reversible method (IUD or implant) before seeing their provider chose one after counseling. Use of a hormonal or long-acting reversible contraceptive method at follow-up was more common among women who had received interactive counseling by providers who guided them to consider contextual influences than among those who had not received such counseling. Attention to relationship characteristics, sexual behavior patterns and STD risk was largely absent from contraceptive counseling.
High-quality strategies used by providers to guide contraceptive decision making were tailored to adolescents' developmental and environmental needs. Several areas of counseling require increased attention and seem vital to providing comprehensive reproductive health care to adolescents.
在美国，不使用和滥用避孕措施导致年轻女性意外怀孕和感染性传播疾病的比率居高不下。临床医疗服务提供者在指导青少年选择避孕方法方面发挥着重要作用。
作为一项队列研究的一部分，2009年至2012年招募了67名年龄在16至21岁之间的女性，该研究考察了旧金山六家诊所计划生育就诊期间的医患互动情况。医患之间的互动进行了录音。参与者在见到医疗服务提供者之前立即填写了关于方法偏好的问卷；就诊后以及三个月和六个月后通过电话报告了方法选择情况。对文字记录进行分析，以研究医疗服务提供者指导决策和解决青少年避孕问题的策略。确定了促进年轻女性生殖健康方面错失的机会。
在见到医疗服务提供者之前未表示希望采用激素或长效可逆方法（宫内节育器或植入剂）的年轻女性中，21%在接受咨询后选择了其中一种方法。在接受了指导她们考虑背景影响的医疗服务提供者进行互动咨询的女性中，随访时使用激素或长效可逆避孕方法的情况比未接受此类咨询的女性更为普遍。避孕咨询中基本没有关注关系特征、性行为模式和性传播疾病风险。
医疗服务提供者用于指导避孕决策的高质量策略是根据青少年的发育和环境需求量身定制的。几个咨询领域需要更多关注，而且似乎对为青少年提供全面的生殖健康护理至关重要。
