Murphy Molly K, Stoffel Cindy, Nolan Meghan, Haider Sadia
Community Health Sciences Division, School of Public Health, University of Illinois-Chicago, Chicago, Illinois.
Department of Obstetrics and Gynecology, University of Illinois-Chicago, Chicago, Illinois.
J Pediatr Adolesc Gynecol. 2016 Oct;29(5):436-442. doi: 10.1016/j.jpag.2016.01.125. Epub 2016 Feb 4.
STUDY OBJECTIVE: Long-acting reversible contraceptive (LARC) methods are the most effective form of reversible contraception but are underutilized by adolescents. The purpose of this study was to identify the context-specific barriers to providing adolescents with LARC that are experienced by pediatricians, family medicine physicians, and advanced practice nurses (APNs). DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS: Pediatricians, family medicine providers, and APNs (n = 16) who care for adolescents participated in semistructured qualitative interviews. Interview data were analyzed using a modified grounded theory approach. MAIN OUTCOME MEASURES: Pediatricians, family medicine physicians, and APNs self-reported attitudes and practices regarding LARC provision to adolescents. RESULTS: Provider confidence in LARC, patient-centered counseling on LARC, and instrumental supports for LARC all work interdependently either in support of or in opposition to provision of LARC to adolescents. Low provider confidence in LARC for adolescents was characterized by confusion about LARC eligibility criteria and perceptions of LARC insertion as traumatic for adolescents. Patient-centered counseling on LARC required providers' ability to elicit patient priorities, highlight the advantages of LARC over other methods, and address patients' concerns about these methods. Instrumental support for LARC included provider training on LARC, access to and financial support for LARC devices, and opportunity to practice LARC insertion and counseling skills. CONCLUSION: Although none of the identified essential components of LARC provision to adolescents exist in isolation, instrumental support like provider training on LARC and access to LARC devices have the most fundamental effect on the other components and on providers' attitudes and practices regarding LARC for adolescents.
研究目的:长效可逆避孕方法是可逆避孕最有效的形式,但青少年对其利用不足。本研究的目的是确定儿科医生、家庭医学医生和高级执业护士(APN)在为青少年提供长效可逆避孕方法时所面临的特定背景障碍。 设计、地点、参与者和干预措施:照顾青少年的儿科医生、家庭医学提供者和APN(n = 16)参与了半结构化定性访谈。访谈数据采用改良的扎根理论方法进行分析。 主要结局指标:儿科医生、家庭医学医生和APN自我报告的关于为青少年提供长效可逆避孕方法的态度和做法。 结果:提供者对长效可逆避孕方法的信心、以患者为中心的长效可逆避孕咨询以及对长效可逆避孕方法的工具性支持,都相互依存地发挥作用,要么支持要么反对为青少年提供长效可逆避孕方法。提供者对青少年长效可逆避孕方法信心低的特点是对长效可逆避孕资格标准感到困惑,以及认为长效可逆避孕植入对青少年来说是有创伤性的。以患者为中心的长效可逆避孕咨询要求提供者有能力引出患者的优先事项,强调长效可逆避孕方法相对于其他方法的优势,并解决患者对这些方法的担忧。对长效可逆避孕方法的工具性支持包括提供者接受长效可逆避孕方法培训、获得长效可逆避孕装置和资金支持,以及有机会练习长效可逆避孕植入和咨询技能。 结论:虽然为青少年提供长效可逆避孕方法的已确定的关键组成部分没有一个是孤立存在的,但像提供者接受长效可逆避孕方法培训和获得长效可逆避孕装置这样的工具性支持,对其他组成部分以及提供者对青少年长效可逆避孕方法的态度和做法具有最根本的影响。
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