UCSF Department of Family & Community Medicine, San Francisco, California; UCSF Department of Obstetrics, Gynecology, & Reproductive Sciences, San Francisco, California; UCSF Department of Epidemiology & Biostatistics, San Francisco, California.
UCSF Department of Family & Community Medicine, San Francisco, California.
Womens Health Issues. 2017 Sep-Oct;27(5):530-538. doi: 10.1016/j.whi.2017.04.005. Epub 2017 Sep 1.
Research in family planning has shown that contraceptive counseling has an influence on women's family planning outcomes, but also that women are often dissatisfied with the counseling they receive. Little is known about how contraceptive counseling is conducted in the United States. We describe both the content and interpersonal quality of provider communication during family planning visits, as well as assess whether disparities in counseling exist by patient race/ethnicity and socioeconomic status.
We obtained audio recordings of contraceptive counseling clinic visits for 339 women ages 15-45, which were coded for content and quality of communication, and collected surveys regarding demographics, contraceptive preferences, and experience with care. We performed descriptive analyses of the content and quality of provider-patient communication, and conducted multivariate logistic regression to assess for racial/ethnic and socioeconomic differences in care.
Providers frequently did not communicate with patients about issues relevant to their family planning needs, including their pregnancy intention (assessed in 51% of visits) and their preferences for birth control (64% of visits). Providers also inconsistently offered patients a chance to ask questions (53% of visits). For most measures, there were no differences by patient race/ethnicity and highest level of parental education achieved. Patients whose parents had a high school education or less were significantly less likely to have long-acting reversible contraceptive methods mentioned during the visit (adjusted odds ratio, 0.42; p = .03).
Several deficiencies in contraceptive counseling were found, suggesting areas for further emphasis in training. Differences by race/ethnicity and socioeconomic states were not marked.
计划生育研究表明，避孕咨询对妇女的计划生育结果有影响，但也有研究表明，女性通常对所接受的咨询不满意。目前，关于美国的避孕咨询是如何进行的，我们知之甚少。我们描述了计划生育就诊期间提供者沟通的内容和人际质量，并评估了患者的种族/民族和社会经济地位是否存在咨询差异。
我们获得了 339 名 15-45 岁女性的避孕咨询诊所访问的录音，这些录音被编码为内容和沟通质量，并收集了关于人口统计学、避孕偏好和护理经验的调查。我们对提供者-患者沟通的内容和质量进行了描述性分析，并进行了多变量逻辑回归分析，以评估护理方面的种族/民族和社会经济差异。
提供者经常没有与患者就与他们的计划生育需求相关的问题进行沟通，包括他们的怀孕意图（在 51%的就诊中评估）和他们对避孕的偏好（64%的就诊中）。提供者也没有为患者提供提问的机会（53%的就诊中）。对于大多数措施，患者的种族/民族和父母接受的最高教育程度没有差异。父母受过高中或以下教育的患者在就诊期间提及长效可逆避孕方法的可能性显著降低（调整后的优势比，0.42；p = 0.03）。
发现了避孕咨询中的几个缺陷，这表明在培训中需要进一步强调。种族/民族和社会经济地位的差异并不明显。
