Degree Name

DrPH (Doctor of Public Health)


Public Health

Date of Award


Committee Chair or Co-Chairs

Deborah Slawson

Committee Members

Katie Baker, Hadii Mamudu


In Tennessee (TN), the rate of unintended pregnancies remains higher than the national rate (32.4% vs. 30.3%). Although long-acting reversible contraceptives (LARCs) are 99% effective in preventing undesired pregnancies; 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 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 administered through REDCap, while qualitative data from focus groups and interviews were recorded via Zoom. Focus groups and interview data were combined, and an 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.

Seventeen themes and 23 sub-themes were identified using the SEM; On the intrapersonal level of the SEM, participants’ contraception utilization history, attitudes towards a method, perception of method features, and perceived side effects were identified as themes that delineate influences on their LARC utilization. Perception of partner support, perceived support from peer/social networks, and provider trust themes were identified on the interpersonal level. 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. The availability of preferred methods in a clinic, the need for multiple clinic visits to use a method, and provider counseling practices were identified as organizational-level themes. On the policy level, insurance, and billing policies, sex education policies were identified as impacting LARC utilization.

Study findings highlight the areas of influence that can be addressed to increase LARC uptake and enable women in rural and underserved regions to achieve their personal reproductive goals.

Document Type

Dissertation - embargo


Copyright by the authors.

Available for download on Saturday, June 15, 2024