Original Contribution  |   November 2019
How Long-Acting Reversible Contraception Knowledge, Training, and Provider Concerns Predict Referrals and Placement
Author Notes
  • From the Department of Communication in the College of Liberal Arts and Sciences at University of Illinois in Urbana (Dr Thompson); and the Department of Obstetrics and Gynecology (Dr Broecker) at the Ohio University Heritage College of Osteopathic Medicine in Athens (Student Doctor Dade). 
  • Financial Disclosures: Dr Broecker has received honoraria from Merck & Co. for being a Nexplanon trainer. 
  • Support: This work was supported by an internal research grant through the Ohio University Heritage College of Osteopathic Medicine. 
  •  *Address correspondence to: Charee M. Thompson, PhD, MA, Department of Communication, College of Liberal Arts and Sciences, University of Illinois at Urbana-Champaign, 702 S Wright St, Urbana, IL 61801-3631. E-mail: charee@illinois.edu
     
Article Information
Obstetrics and Gynecology / Pediatrics / Practice Management
Original Contribution   |   November 2019
How Long-Acting Reversible Contraception Knowledge, Training, and Provider Concerns Predict Referrals and Placement
The Journal of the American Osteopathic Association, November 2019, Vol. 119, 725-734. doi:https://doi.org/10.7556/jaoa.2019.122
The Journal of the American Osteopathic Association, November 2019, Vol. 119, 725-734. doi:https://doi.org/10.7556/jaoa.2019.122
Abstract

Context: Providing long-acting reversible contraception (LARC; eg, subdermal implants and intrauterine devices [IUDs]) can help mitigate rates of unintended pregnancy because they are the most effective reversible contraceptive methods. However, many varied barriers to LARC placement are reported. Medical education and training can be tailored if there is a better understanding of how barriers predict LARC referral and to predicting LARC placement.

Objective: To understand how a variety of key barriers to LARC placement are related to one another; to identify which of the barriers, when considered simultaneously, predict LARC referral and LARC placement; and to assess the barriers to LARC placement that persist, even when a major barrier, training, is removed.

Methods: We recruited providers (obstetricians and gynecologists, family physicians, pediatricians, internal medicine physicians, certified nurse practitioners, and certified nurse midwives) across the state of Ohio. Participants were compensated with a $35 Amazon gift card for completing an online survey comprising 38 Likert-type items, an 11-item knowledge test, LARC placement and referral questions, and demographic questions. We conducted data analyses that included correlations, odds ratios, and independent samples t tests.

Results: A total of 224 providers participated in the study. Long-acting reversible contraception knowledge, training, and provider concerns were correlated with one another. Training was found to positively predict placement and negatively predict referral when other barriers, such as knowledge and provider concerns, were considered simultaneously. Of providers who were trained to place implants, 18.6% (n=16) said they referred implant placement, and 17.4% (n=15) said they did not place implants. Of providers who were trained to place IUDs, 26.3% (n=26) said they referred IUD placement, and 27.3% (n=27) said they did not place IUDs. Those who referred placement and those who did not place LARCs reported greater barriers (in type and magnitude) to LARC placement than those who did place LARCs.

Conclusion(s): Long-acting reversible contraception knowledge, training, and provider concerns about barriers to LARC placement were interdependent. Even when providers were trained to place LARCs, a significant portion referred or did not place them. Efforts to increase LARC placement need to address multifaceted barriers.

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