Perceived Control in Past Contraceptive Experiences as a Lasting Influence on Contraceptive Behavior: A Focus Group Exploration in Urban African American Women

Research Article

J Fam Med. 2014;1(1): 6.

Perceived Control in Past Contraceptive Experiences as a Lasting Influence on Contraceptive Behavior: A Focus Group Exploration in Urban African American Women

Ricco JA1*, Attanasio L2, Bergeson K1 and Prasad S1

1Department of Family Medicine and Community Health, University of Minnesota, USA

2Division of Health Policy and Management, University of Minnesota, USA

*Corresponding author: Ricco JA, Department of Family Medicine and Community Health, University of Minnesota, 1020 West Broadway, Minneapolis, MN 55411, USA

Received: July 24, 2014; Accepted: Aug 04, 2014; Published: Aug 08, 2014

Abstract

Introduction: Marked racial disparities persist in the United States in both unintended pregnancy rates and contraceptive use despite widespread availability and efficacy of hormonal contraception. We explored barriers to contraceptive use among African American women using the Integrative Model of Behavioral Prediction as a framework for assessing the impact of past contraceptive experiences, including provider interactions, on behavior.

Materials and Methods: We conducted four focus groups consisting of 20 African American women between the ages of 18 and 50 years at an urban, underserved Family Medicine residency clinic. The Integrative Model of Behavioral Prediction was used as a theoretical framework to construct focus group questions. Using a deductive approach, we performed thematic analysis using QSR NVivo 10 to identify major themes.

Results: The major themes during focus groups were 1) a lack of perceived control at contraception initiation as an adolescent, 2) negative perceptions of provider encounters based on past experiences, and 3) contraceptive side effects as the most important factor influencing contraceptive choice.

Conclusion: Our findings suggest that a lack of perceived control in contraceptive decision-making during past clinical encounters may have a lasting influence on contraceptive behavior. Further research is needed to identify strategies to improve patient-provider communication in this population, particularly related to the first contraceptive encounter.

Keywords: Contraception, Health Disparities, African American, Self-Efficacy, Perceived Control, Women’s Health

Abbreviations

PCMH: Patient-Centered Medical Home

Introduction

Despite widespread availability and efficacy of hormonal contraception, as many as 49% of all pregnancies in the United States are unintended [1,2]. Racial and socioeconomic disparities add to the burden of unintended pregnancy, with rates among African American adolescents at three times that of non-Hispanic White teens [3]. Racial disparities in contraceptive nonuse and high-risk usage gaps are consistent with the higher rates of unintended pregnancy among African American and Hispanic women, and persist even after adjustment for income and insurance coverage [4]. This suggests that factors other than cost and access drive contraceptive racial disparities- such as the perception of provider support and beliefs regarding safety and side effects [3-5].

Previous research with African American women focused primarily on specific barriers to contraceptive use such as access, concern about the side effects and safety, or has explored the influence that social networks have as sources of contraceptive information [5-9]. Less is known about how perceived control and outcome valuations in past contraceptive experiences affect contraceptive use behaviors in adult African American women. Furthermore, the role of the clinical encounter as a pivotal site for contraceptive decision-making that is influenced by interactions with the provider is relatively unexplored.

Studies that apply theoretical frameworks have been more successful in predicting contraceptive behavior [10-12]. The Integrative Model of Behavioral Prediction incorporates the concepts of perceived behavioral control and self-efficacy that have proven useful as predictors of both contraceptive intention and behavior in some populations (Figure1) (10,13,14). The purpose of this study is to explore barriers to contraceptive use among African American women using the Integrative Model of Behavioral Prediction as a framework for assessing the impact of past contraceptive experiences, including provider interactions, and attitudes on current behavior.

Methods

Subjects and setting

We conducted four focus groups over three months at an urban, underserved Family Medicine residency clinic in a large city in the upper Midwest. The clinic is a certified Patient-Centered Medical Home (PCMH) with a 30-year relationship with the community,and serves a predominantly African American patient population (approximately 90%). The 40 providers, including 30 residents, seeabout 28,000 patient visits per year. We identified non-pregnant African American women between the ages of 18 and 50 years who receive their primary care from clinic as our target population for this study. Adolescents were not included as the goal was to assess the impact of past contraceptive experiences on current behavior.

Instruments

The Integrative Model of Behavioral Prediction (Figure 1) was used as a theoretical framework to guide focus group question design and organization. This model specifies that a behavior is likely to occur when one has a strong intention to perform the behavior, if a person has the required skills, and when there are no environmental barriers to performing the behavior. Intention is influenced by (a) a person’s attitude toward performing the behavior and is based on beliefs of positive and negative consequences; (b) the perceived norms within the community and among social supports; and (c) self-efficacy, a person’s perception that they can perform the behavior under challenging circumstances (13,15-17).We applied the model’s three intention domains (attitudes, norms, and self-efficacy) along with the concepts of perceived control over external barriers and skills (i.e. knowledge) to contraceptive behavior and decision-making, ultimately developing twelve open-ended focus group questions.

Citation:Ricco JA, Attanasio L, Bergeson K and Prasad S. Perceived Control in Past Contraceptive Experiences as a Lasting Influence on Contraceptive Behavior: A Focus Group Exploration in Urban African American Women. J Fam Med. 2014;1(1): 6. ISSN:2380-0658