‘We’re kidding ourselves if we say that contraception is accessible’: a qualitative study of general practitioners’ attitudes towards adolescents’ use of long-acting reversible contraceptives (LARC)
Rebecca Duncan 1 2 3 , Helen Paterson 1 2 , Lynley Anderson 1 2 , Neil Pickering 1 21 Bioethics Centre, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
2 Department of Women’s and Children's Health, Dunedin School of Medicine, PO Box 56, Dunedin 9054, New Zealand.
3 Corresponding author. Email: dunre441@student.otago.ac.nz
Journal of Primary Health Care 11(2) 138-145 https://doi.org/10.1071/HC18105
Published: 18 July 2019
Journal Compilation © Royal New Zealand College of General Practitioners 2019.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: Adolescents’ uptake of long-acting reversible contraceptives (LARCs) in New Zealand is low. We created the concept of a proactive LARC provision programme to overcome barriers to LARC uptake. Previously, this concept was discussed with adolescents and positively received. Lack of provider awareness is a barrier to LARC use identified in previous research and by adolescents.
AIM: We sought the views of general practitioners (GPs) to gauge whether LARCs and their proactive promotion for use in adolescents may be acceptable to GPs.
METHODS: Nine New Zealand GPs were interviewed about their contraception provision to adolescents and were then asked to comment on the concept of a proactive LARC provision programme. The data collected were transcribed and analysed using a general inductive approach to identify common themes and ideas. We concurrently interviewed and analysed interviews and continued to recruit GPs until thematic saturation was reached.
RESULTS: Six themes were identified from the interviews: (1) contraceptive decision making; (2) the GP role; (3) sexual activity; (4) social context; (5) gauging adolescent understanding; and (6) youth. When we proposed the concept of a proactive LARC provision programme, the GPs responded positively.
DISCUSSION: The research demonstrates that LARC uptake is affected by limited provider awareness. These findings align with other research internationally that identifies barriers to adolescent contraceptive use. The findings of this study suggest that other GPs may support a proactive LARC provision programme in New Zealand.
KEYwords: Access; general practice.
References
[1] Lawton B, Makowharemahihi C, Cram F, et al. Pounamu: E Hine: access to contraception for indigenous Mãori teenage mothers. J Prim Health Care 2016; 8 52–9.| Pounamu: E Hine: access to contraception for indigenous Mãori teenage mothers.Crossref | GoogleScholarGoogle Scholar | 27477375PubMed |
[2] ACOG ACOG Committee opinion no. 539: adolescents and long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol 2012; 120 983–8.
| ACOG Committee opinion no. 539: adolescents and long-acting reversible contraception: implants and intrauterine devices.Crossref | GoogleScholarGoogle Scholar | 22996129PubMed |
[3] Winner B, Peipert JF, Zhao Q, et al. Effectiveness of long-acting reversible contraception. N Engl J Med 2012; 366 1998–2007.
| Effectiveness of long-acting reversible contraception.Crossref | GoogleScholarGoogle Scholar | 22621627PubMed |
[4] Family Planning. Contraceptive statistics – our local data. Family Planning E-News Update. March 2015.
[5] Moreno MA. Long-acting reversible contraception for adolescents. JAMA Pediatr 2016; 170 516
| Long-acting reversible contraception for adolescents.Crossref | GoogleScholarGoogle Scholar | 27135396PubMed |
[6] Smith SA. The use of intrauterine devices (IUDs) in adolescents and nulliparous women: a systematic review. J Women's Health Care 2015; 2015
[7] Miller D. Equity in sexual and reproductive health – an ongoing challenge. J Prim Health Care 2016; 8 3–4.
| Equity in sexual and reproductive health – an ongoing challenge.Crossref | GoogleScholarGoogle Scholar | 27477367PubMed |
[8] Pickering N, Anderson L, Paterson H. Authors’ reply re: Teens and young adults should be started on longacting reversible contraceptives before sexual activity commences. Br J Obstetr Gynaecol 2015; 122 1848–9.
| Authors’ reply re: Teens and young adults should be started on longacting reversible contraceptives before sexual activity commences.Crossref | GoogleScholarGoogle Scholar |
[9] Pickering N, Anderson L, Paterson H. Teens and young adults should be started on long‐acting t.b. contraceptives before sexual activity commences: FOR: an opt‐out programme would avoid teen pregnancy and associated costs. Br J Obstetr Gynaecol 2015; 122 1052
| Teens and young adults should be started on long‐acting t.b. contraceptives before sexual activity commences: FOR: an opt‐out programme would avoid teen pregnancy and associated costs.Crossref | GoogleScholarGoogle Scholar |
[10] Duncan R, Paterson H, Anderson L, Pickering N. A qualitative analysis of adolescents’ opinions of proactive long-acting reversible contraceptive (LARC) provision. N Z Med J 2019; 132 38–48.
[11] Broughton HO, Buckel CM, Omvig KJ, et al. From research to practice: dissemination of the Contraceptive CHOICE Project. Translat Behavior Med 2016; 7 1–9.
[12] Coates C, Phillips J, Means K, Simpson T. Contraceptive practices of sexually active adolescent females and the barriers to their use of long-acting reversible contraceptives. J Pediatr Adolesc Gynecol 2017; 30 327
| Contraceptive practices of sexually active adolescent females and the barriers to their use of long-acting reversible contraceptives.Crossref | GoogleScholarGoogle Scholar |
[13] da Silva-Filho AL, Lira J, Rocha ALL, Carneiro MM. Barriers and myths that limit the use of intrauterine contraception in nulliparous women: a survey of Brazilian gynaecologists. Postgrad Med J 2017; 93 376–81.
| 27780879PubMed |
[14] Garrett CC, Keogh LA, Kavanagh A, et al. Understanding the low uptake of long-acting reversible contraception by young women in Australia: a qualitative study. BMC Womens Health 2015; 15 72
| Understanding the low uptake of long-acting reversible contraception by young women in Australia: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 26359250PubMed |
[15] New Zealand Ministry of Health. Overview of the health system. Wellington: Ministry of Health; 2017. [Cited 2018 April 3]. Available from: https://www.health.govt.nz/new-zealand-health-system/overview-health-system
[16] Pegasus Health. New Zealand’s health care system. 2014. Available from: https://www.pegasus.health.nz/wp-content/uploads/2018/03/NZ-Health-System-booklet-English.pdf
[17] Harper CC, Blum M, de Bocanegra HT, et al. Challenges in translating evidence to practice: the provision of intrauterine contraception. Obstet Gynecol 2008; 111 1359–69.
| Challenges in translating evidence to practice: the provision of intrauterine contraception.Crossref | GoogleScholarGoogle Scholar | 18515520PubMed |
[18] Moreau C, Bohet A, Hassoun D, et al. IUD use in France: women’s and physician’s perspectives. Contraception 2014; 89 9–16.
| IUD use in France: women’s and physician’s perspectives.Crossref | GoogleScholarGoogle Scholar | 24239330PubMed |
[19] Luchowski AT, Anderson BL, Power ML, et al. Obstetrician–gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations. Contraception 2014; 89 572–7.
| Obstetrician–gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations.Crossref | GoogleScholarGoogle Scholar | 24679477PubMed |
[20] Paterson H, Miller D, Devenish C. A survey of New Zealand RANZCOG Fellows on their use of the levonorgestrel intrauterine device in adolescents. Aust N Z J Obstet Gynaecol 2009; 49 220–5.
| A survey of New Zealand RANZCOG Fellows on their use of the levonorgestrel intrauterine device in adolescents.Crossref | GoogleScholarGoogle Scholar | 19432616PubMed |
[21] Denis L, Storms M, Peremans L, et al. Contraception: a questionnaire on knowledge and attitude of adolescents, distributed on Facebook. Int J Adolesc Med Health 2016; 28 407–12.
| 26581063PubMed |
[22] Marshall MN. Sampling for qualitative research. Fam Pract 1996; 13 522–5.
| Sampling for qualitative research.Crossref | GoogleScholarGoogle Scholar | 9023528PubMed |
[23] Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Eval 2006; 27 237–46.
| A general inductive approach for analyzing qualitative evaluation data.Crossref | GoogleScholarGoogle Scholar |
[24] Gillick v. West Norfolk and Wisbech Area Health Authority. AC1986. p. 112.
[25] Medical Council of New Zealand. Medical Council of New Zealand Annual Report 2016. 2017. Available from: https://www.mcnz.org.nz/assets/Publications/Annual-Reports/956bca6617/MCNZ-Annual-Report-2016.pdf
[26] Braun V, Clarke V. Successful Qualitative Research: A Practical Guide for Beginners. London: Sage; 2013.
[27] Dixon SC, Herbert DL, Loxton D, Lucke JC. ‘As many options as there are, there are just not enough for me’: contraceptive use and barriers to access among Australian women. Eur J Contracept Reprod Health Care 2014; 19 340–51.
| ‘As many options as there are, there are just not enough for me’: contraceptive use and barriers to access among Australian women.Crossref | GoogleScholarGoogle Scholar | 24901891PubMed |
[28] Carvajal DN, Gioia D, Mudafort ER, et al. How can primary care physicians best support contraceptive decision making? A qualitative study exploring the perspectives of Baltimore Latinas. Womens Health Issues 2017; 27 158–66.
| How can primary care physicians best support contraceptive decision making? A qualitative study exploring the perspectives of Baltimore Latinas.Crossref | GoogleScholarGoogle Scholar | 27825590PubMed |
[29] Davis D, Davis ME, Jadad A, et al. The case for knowledge translation: shortening the journey from evidence to effect. BMJ 2003; 327 33–5.
| The case for knowledge translation: shortening the journey from evidence to effect.Crossref | GoogleScholarGoogle Scholar | 12842955PubMed |
[30] Family Planning Alliance Australia. Long Acting Reversible Contraception (LARC): Position Statement. Brisbane: Australia Family Planning Alliance; 2014.
[31] Philliber AE, Hirsch H, Brindis CD, et al. The use of ACOG guidelines: perceived contraindications to iud and implant use among family planning providers. Matern Child Health J 2017; 21 1706–12.
| The use of ACOG guidelines: perceived contraindications to iud and implant use among family planning providers.Crossref | GoogleScholarGoogle Scholar | 28707101PubMed |
[32] Laski L. Realising the health and wellbeing of adolescents. BMJ 2015; 351 h4119
| 26371214PubMed |
