Exploring Women's Acceptance of a Contraception Intervention in the Emergency Department: A Mixed Methods Study
Caldwell MT, Polk H, Hambrick NJ, Vallee P, Robinson A, Goyal N, Manteuffel J, and Guetterman T. Exploring women's acceptance of a contraception intervention in the emergency department: A mixed methods study. Acad Emerg Med 2017; 24:S165.
Acad Emerg Med
Background: Up to 45% of pregnancies in the US are unintended (meaning mistimed or unwanted), resulting in significant social, health and monetary costs for families and society. Unintended pregnancies disproportionately affect adolescents, Blacks and Latinas, and women with low income and educational level. These populations are also more likely to utilize the Emergency Department (ED) for non-urgent complaints. Therefore, the ED may be a novel setting to deliver contraception services to improve health inequities.
Objective: To determine acceptable components of a contraception counseling and initiation intervention in the ED among diverse reproductive-aged women.
Methods: An exploratory sequential mixed methods design was used. Diverse women, 15-44 years, at risk for unintended pregnancy completed brief demographic surveys. Semi-structured interviews were conducted using a piloted interview guide in a large, urban ED until data saturation was reached. Interviews were transcribed and de-identified. Inductive thematic text analysis was performed iteratively. Inter-coder agreement was 80% or higher, with an average Kappa coefficient of 0.79.
Results: We conducted 30 interviews. Participants were 66% Black, with 27% adolescents. Overall, acceptance of contraception counseling and initiation in the ED was high. Counseling preferences included: 1) counseling on all contraceptive options, 2) experienced and relatable female contraception counselors, 3) counseling approaches with both interpersonal and technological components, and 4) acceptance of non-medical personnel as contraception counselors. Women were generally accepting of starting a contraceptive method in the ED, though preferred methods largely correlated with women's previous knowledge of contraception. Participants noted reliance on vicarious peer experiences when forming opinions about contraceptive methods, often resulting in negative feelings about intrauterine devices and implants and a reluctance to accept these devices in the ED.
Conclusion: Diverse women at risk for unintended pregnancy have favorable opinions of receiving contraception counseling and initiation in the ED. Preferences for an ED-based intervention should be further explored within a larger population to inform future contraception interventions in this novel setting.