Urban Adolescents' and Young Adults' Decision-Making Process around Selection of Intrauterine Contraception

Abstract

Study objective: To examine adolescent and young adults' priorities, values, and preferences affecting the choice to use an intrauterine contraceptive device (IUD).

Design: Qualitative exploratory study with analysis done using a modified grounded theory approach.

Setting: Outpatient adolescent medicine clinic located within an academic children's hospital in the Bronx, New York.

Participants: Twenty-seven women aged 16 to 25 years of age on the day of their IUD insertion.

Interventions and main outcome measures: We conducted semistructured interviews exploring participant's decision making process around selecting an IUD. We were specifically interested in elucidating factors that could potentially improve IUD counseling.

Results: We identified 4 broad factors affecting choice: (1) personal; (2) IUD device-specific; (3) health care provider; and (4) social network. Most of the participants perceived an ease with a user-independent method and were attracted by the high efficacy of IUDs, potential longevity of use, and the option to remove the device before its expiration. Participants described their health care provider as being the most influential individual during the IUD decision-making process via provision of reliable, accurate contraceptive information and demonstration of an actual device. Of all people in their social network, mothers played the biggest role.

Conclusion: Adolescents and young women who choose an IUD appear to value the IUDs' efficacy and convenience, their relationship with and elements of clinicians' contraceptive counseling, and their mother's support. Our results suggest that during IUD counseling, clinicians should discuss these device-specific benefits, elicit patient questions and concerns, and use visual aids including the device itself. Incorporating the factors we found most salient into routine IUD counseling might increase the number of adolescents and young women who choose an IUD as a good fit for them.

Keywords: Adolescent; Contraception; Contraception decision-making; Counseling; Decision-making; Female; Intrauterine devices; Qualitative research; Reproductive health.