Project Title

Perceptions, knowledge, and attitudes about Long-Acting Reversible Contraceptives (LARCs) among Women in Appalachian Tennessee

Authors' Affiliations

Fenose Osedeme, MS, MPH, DrPH(c), Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN 37614 Katie Baker, DrPH, MPH, Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN 37614 Hadii Mamudu, PhD, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN. The Center for Cardiovascular Risk Research, College of Public Health, East Tennessee State University. TN 37614 Deborah L. Slawson, Ph.D., R.D., L.D.N, Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN 37614

Location

Culp Forum 311

Start Date

4-6-2022 10:00 AM

End Date

4-6-2022 11:00 AM

Faculty Sponsor’s Department

Community & Behavioral Health

Name of Project's Faculty Sponsor

Deborah Slawson

Additional Sponsors

Katie Baker, Hadii Mamudu

Classification of First Author

Graduate Student-Doctoral

Competition Type

Competitive

Type

Oral Presentation

Project's Category

Womens Health

Abstract or Artist's Statement

Patient-centered contraceptive care is key for ensuring that individuals achieve their personal reproductive goals. Despite public health efforts, preventing undesired pregnancies and improving maternal and child health outcomes remains unresolved in the United States (US). In Tennessee (TN), the rate of unintended pregnancies remains higher than the national rate (32.4% vs. 30.3%). Long-acting reversible contraceptives (LARCs) are 99% effective in preventing undesired pregnancies; however, uptake remains low in rural and underserved communities. Previous research has provided some insight into women’s perceptions of LARCs; however, those guided by conceptual frameworks to understand the multiple influences that impact perceptions towards LARCs, especially among rural regions, are scarce. This multimethod qualitative study explored multiple influences that impact northeast Tennessee women’s perceptions and attitudes toward LARCs using the Socio-ecological Model (SEM) as a guiding framework. The qualitative study comprised six focus groups and seven individual interviews of women aged 18-44, not pregnant, and current residents of five Counties in Northeast TN. Participants’ demographics were captured through an anonymous survey administered through REDCap. Qualitative data from these sessions were recorded via Zoom, an online audio/video conferencing platform. Each interview and focus group lasted 60 to 90 minutes. Focus group and interview data were combined, transcribed, and uploaded into NVivo for thematic analysis. A priori list of codes identified from the constructs of the SEM was initially used to deductively code the data. Subsequently, the data were analyzed inductively for new codes and themes that did not apply to the a priori categories. Quotations that were representative of or inconsistent with the codes of interest were identified. Fifteen themes and 20 sub-themes were identified using the SEM; On the intrapersonal level of the SEM, participants’ attitudes towards a method, perception of method features, and perceived side effects were identified as themes that delineate influences on their LARC utilization. On the interpersonal level, perception of partner support, perceived support from peer/social networks, and provider trust were themes that describe influences on participants’ LARC utilization. On the community level, the cost of the method, access to information, perceived accessibility to a method, social services, and cultural norms themes were identified as influences on participants’ use of LARCs. On the organizational level, the availability of preferred methods in a clinic, the need for multiple clinic visits to enable the use of a method, and provider counseling practices were salient themes impacting LARC utilization. On the policy level, insurance, and billing policies, sex education policies were identified as impacting LARC utilization. The study presents multi-layered influences on LARC utilization among Northeast TN women, highlighting the utility of the SEM in understanding factors that influence contraceptive use. Findings are critical for programming as they highlight the areas of influence that can be addressed to increase LARC uptake and enable women in rural and underserved regions of the US to achieve personal reproductive goals.

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Apr 6th, 10:00 AM Apr 6th, 11:00 AM

Perceptions, knowledge, and attitudes about Long-Acting Reversible Contraceptives (LARCs) among Women in Appalachian Tennessee

Culp Forum 311

Patient-centered contraceptive care is key for ensuring that individuals achieve their personal reproductive goals. Despite public health efforts, preventing undesired pregnancies and improving maternal and child health outcomes remains unresolved in the United States (US). In Tennessee (TN), the rate of unintended pregnancies remains higher than the national rate (32.4% vs. 30.3%). Long-acting reversible contraceptives (LARCs) are 99% effective in preventing undesired pregnancies; however, uptake remains low in rural and underserved communities. Previous research has provided some insight into women’s perceptions of LARCs; however, those guided by conceptual frameworks to understand the multiple influences that impact perceptions towards LARCs, especially among rural regions, are scarce. This multimethod qualitative study explored multiple influences that impact northeast Tennessee women’s perceptions and attitudes toward LARCs using the Socio-ecological Model (SEM) as a guiding framework. The qualitative study comprised six focus groups and seven individual interviews of women aged 18-44, not pregnant, and current residents of five Counties in Northeast TN. Participants’ demographics were captured through an anonymous survey administered through REDCap. Qualitative data from these sessions were recorded via Zoom, an online audio/video conferencing platform. Each interview and focus group lasted 60 to 90 minutes. Focus group and interview data were combined, transcribed, and uploaded into NVivo for thematic analysis. A priori list of codes identified from the constructs of the SEM was initially used to deductively code the data. Subsequently, the data were analyzed inductively for new codes and themes that did not apply to the a priori categories. Quotations that were representative of or inconsistent with the codes of interest were identified. Fifteen themes and 20 sub-themes were identified using the SEM; On the intrapersonal level of the SEM, participants’ attitudes towards a method, perception of method features, and perceived side effects were identified as themes that delineate influences on their LARC utilization. On the interpersonal level, perception of partner support, perceived support from peer/social networks, and provider trust were themes that describe influences on participants’ LARC utilization. On the community level, the cost of the method, access to information, perceived accessibility to a method, social services, and cultural norms themes were identified as influences on participants’ use of LARCs. On the organizational level, the availability of preferred methods in a clinic, the need for multiple clinic visits to enable the use of a method, and provider counseling practices were salient themes impacting LARC utilization. On the policy level, insurance, and billing policies, sex education policies were identified as impacting LARC utilization. The study presents multi-layered influences on LARC utilization among Northeast TN women, highlighting the utility of the SEM in understanding factors that influence contraceptive use. Findings are critical for programming as they highlight the areas of influence that can be addressed to increase LARC uptake and enable women in rural and underserved regions of the US to achieve personal reproductive goals.