The purpose of this research project is to develop a clinical practice guideline for contraceptive counseling to include long acting reversible contraceptive (LARC) recommendations for the adolescent population. LARCs, which include intrauterine devices and implants, are the top-tier contraceptive for nulliparous women yet they are only used in less than 6% of women under 19 years old. There is no LARC clinical practice guideline that addresses the adolescent’s unique developmental and psychosocial needs that arise. A clinical practice guideline with adolescent-specific recommendations will strengthen counseling especially for long-acting reversible contraceptives. The review of literature searched PubMed, CINHAL, National Guideline Clearinghouse, Google Scholar and the Cochrane Library using search terms "LARCs," and "contraceptive counseling." The search yielded over 35,000 results; titles and abstracts were reviewed using pre-determined inclusion and exclusion criteria. The final source documents included forty-eight applicable manuscripts, which were graded using the United States Preventative Task Force (USPSTF) scale. The evidence was then sorted by similar findings and practice recommendations. The findings were used to formulate practice statements, which were then input into the Bridge-wiz software. The program generated recommendations and assigned a strength rating, and the clinical practice guideline was written from these recommendations. Finally, four clinical experts were identified using snowball sampling; they each participated in the final appraisal using the AGREE II tool. Based on the analysis of the review of literature, fifteen evidenced-based recommendations emerged. The recommendation topics included: best-practices for recommending LARCs, using developmentally appropriate teaching, providing youth-friendly services, and eliminating potential barriers to LARC uptake in adolescents. There are fifteen practice recommendations that increase adolescent uptake of LARCs. Limitations for the project included the absence of an internal review committee to grade the evidence and assign a strength to each recommendation. The use of Bridge-wiz software and the USPSTF evidence scale minimized bias. Providers can facilitate use of LARCs among adolescents by using developmentally appropriate and comprehensive contraceptive counseling. If more adolescents chose a LARC as their primary form of contraception, then overall teenage pregnancies may decrease. Further research is needed to understand other barriers and possible interventions.

Magister Curationis - MCur / Increasing numbers of unintended pregnancies are occurring due to contraceptive failure. Unsafe abortion remains one of the top five avoidable patient-related causes of maternal death in South Africa. There are much higher reported failure rates for short-acting methods of contraceptives than long-acting methods of contraceptives; the uptake of long-acting methods of contraception though remains low.

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.

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.

Contraceptive use has far-reaching social and health benefits for women in low and middle-income countries. While socioeconomic factors are known to be associated with contraceptive use, few studies on this topic have focused specifically on young women, whose reproductive health is a target of the Sustainable Development Goals and the Family Planning 2020 agenda. This study used the Kenya Demographic and Health Survey to examine the association between three social determinants (wealth, education, and residence) and two contraceptive outcomes (modern method use and long-acting reversible contraceptive [LARC] use) in women ages 15-24 in 2008-09 (n=3,211 women) and 2014 (n=4,982 women). Results showed increases in the prevalence of modern method use and of LARC use. Low wealth was associated with non-use of LARC methods, and the same wealth pattern emerged for all modern method use between the two timepoints. An education gradient was observed for both outcomes. This study provides some evidence that the urban-rural gap is closing for contraception; however, rural residence continues to be a strong predictor of non-use of LARC methods. Results indicate that continued work is needed to ensure equitable progress in contraceptive use and method choice to contribute to improved reproductive health for young Kenyan women.

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