Provider perspectives on patient-centered contraceptive counseling for Latinas in Baltimore, MD

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OBJECTIVES: This study explores: 1) provider narratives of their contraceptive counseling practices with Latina patients within the context of patient-centered care (PCC); and 2) provider perceptions about the barriers to the provision of patient-centered contraceptive counseling in general and more specifically, with Latina patients in Baltimore, MD.

STUDY DESIGN: We conducted 25 semi-structured qualitative interviews with physicians (MD/DO) and nurse practitioners from four specialties (family medicine, internal medicine, pediatrics, obstetrics/gynecology) who provide contraceptive care to Latinas in Baltimore, MD. We analyzed data using a directed content analysis approach. We discuss findings with attention to major constructs of PCC, applying a reproductive justice framework.

RESULTS: Providers described a contraceptive counseling approach focused on pregnancy prevention as the primary goal during contraceptive encounters with Latina patients. Most respondents described using a tiered-effectiveness approach when counseling even while noting the importance of PCC and its main tenets. Providers noted both health system and patient-attributed barriers to PCC. Health system barriers to PCC included time constraints and insurance status. Patient-attributed barriers reported by providers included low patient education/health literacy, culturally-attributed misconceptions about contraception, and the language barrier.

CONCLUSION: Providers described knowledge of and intention to practice PCC during contraceptive care but had limited integration of it in their own counseling practices with Latinas. Provider responses suggest tension between an expressed desire to provide PCC and paternalistic counseling paradigms that prioritize the prevention of unintended pregnancy over patient preferences. Moreover, inequitable health system barriers also interfere with true implementation of contraceptive PCC.

IMPLICATIONS: Translating contraceptive PCC into practice, especially for marginalized communities, is paramount. Training should teach clinicians to recognize systems of structural inequity and discrimination that have informed approaches to counseling but are not reflective of PCC. Institutional policies must address health system barriers (e.g., time constraints; insurance) that also hamper PCC.

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ePub ahead of print

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