Perceived Contraceptive Counseling Quality Among Veterans Using VA Primary Care: Data from the ECUUN Study

J Gen Intern Med. 2022 Sep;37(Suppl 3):698-705. doi: 10.1007/s11606-022-07586-2. Epub 2022 Aug 30.

Abstract

Background: High-quality contraceptive counseling is critical to support Veterans' reproductive autonomy and promote healthy outcomes.

Objective: To describe perceived quality of contraceptive counseling in Veterans Health Administration (VA) primary care and assess factors associated with perceived high- and low-quality contraceptive counseling.

Design: Cross-sectional study using data from the Examining Contraceptive Use and Unmet Need in women Veterans (ECUUN) national telephone survey.

Participants: Veterans aged 18-44 who received contraceptive services from a VA primary care clinic in the past year (N=506).

Main measures: Perceived quality of contraceptive counseling was captured by assessing Veterans' agreement with 6 statements regarding provider counseling adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. High-quality counseling was defined as a top score of strongly agreeing on all 6 items; low-quality counseling was defined as not agreeing (neutral, disagreeing, or strongly disagreeing) with >3 items. We constructed two multivariable models to assess associations between patient-, provider-, and system-level factors and perceived high-quality (Model 1) and perceived low-quality counseling (Model 2).

Key results: Most participants strongly agreed that their providers listened carefully (74%), explained things clearly (77%), and spent enough time discussing things (71%). Lower proportions strongly agreed that their provider discussed more than one option (54%), discussed pros/cons of various methods (44%), or asked which choice they thought was best for them (62%). In Model 1, Veterans who received care in a Women's Health Clinic (WHC) had twice the odds of perceiving high-quality counseling (aOR=1.99; 95%CI=1.24-3.22). In Model 2, Veterans who received care in a WHC (aOR=0.49; 95%CI=0.25-0.97) or from clinicians who provide cervical cancer screening (aOR=0.49; 95%CI=0.26-0.95) had half the odds of perceiving low-quality counseling.

Conclusions: Opportunities exist to improve the quality of contraceptive counseling within VA primary care settings, including more consistent efforts to seek patients' perspectives with respect to contraceptive decisions.

Keywords: contraceptive counseling; patient-centered care; primary care; provider-patient communication; women Veterans.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Contraceptive Agents
  • Counseling
  • Cross-Sectional Studies
  • Early Detection of Cancer
  • Female
  • Humans
  • Primary Health Care
  • United States
  • United States Department of Veterans Affairs
  • Uterine Cervical Neoplasms*
  • Veterans* / psychology

Substances

  • Contraceptive Agents