Accepted for/Published in: JMIR Formative Research
Date Submitted: Mar 15, 2023
Date Accepted: Jul 4, 2023
Clinicians’ Perspectives and Proposed Solutions to Improve Contraceptive Counseling in the United States: A Qualitative Study
ABSTRACT
Background:
Patients’ challenges with contraceptive counseling and decision making are well documented, but clinicians’ challenges in providing counseling and decision support have been minimally explored.
Objective:
The objective of this study is to elicit clinicians’ perspectives on patients’ contraceptive decision-making needs and current contraceptive counseling practices to inform efforts to improve decision aids and other tools to aid clinicians in providing patient-centered counseling.
Methods:
We conducted semi-structured interviews with 15 experienced United States-based family planning-focused clinicians from the Society of Family Planning professional society. An inductive content analysis approach revealed themes within our data. All transcripts were coded with an evolving codebook, with the first five transcripts recoded from the finalized codebook.
Results:
Twelve medical doctors and three nurse practitioners with an average of 19 years of experience participated. Our content analysis revealed three main barriers to the provision of quality patient-centered contraceptive counseling: patient and clinician biases that impede patient-clinician communication, time constraints, and gaps in patient sexual health knowledge. Clinicians suggested multi-level solutions to facilitate patient-centered counseling, including additional sexual health education and the use of decision tools.
Conclusions:
Based on these qualitative findings, solutions like patient decision aids should be improved upon to acknowledge time constraints, address patient and clinician biases, and create a foundation of sexual health knowledge. The family planning clinicians in our study also identified clinician- and system-level changes, including improved clinician training and outlets for addressing patient sexual health knowledge gaps, necessary for promoting patient-centered contraceptive counseling. A multi-level approach must be used to improve the overall quality of contraceptive counseling and care.
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