Intrauterine contraception tied to satisfaction, confidence and low switching intentions by users: Study
Contraceptive behaviors are key determinants of unintended pregnancy. Some behaviors include contraceptive discontinuation or switching. Discontinuation is stopping use of a method whereas switching involves stopping one method and beginning another method. According to the theory of planned behavior, intention to engage in a behavior is the main precursor to engaging in a behavior. In addition, attitudes such as satisfaction and beliefs regarding personal control as assessed by confidence in one's ability to perform the behavior are precursors to actual engagement in behavior and they may have an effect entirely through intentions. Intentions to switch a contraceptive method is a key determinant of actual switching of a method, and satisfaction with method and confidence in use of a method may affect individuals' switching intentions.
Method satisfaction, confidence in use, and contraceptive behavioral intentions have been found to be associated with contraceptive behaviors. Contraceptive switching intentions are important because switching a method is frequently accompanied by gaps in contraceptive use, and those gaps increase risk of unintended pregnancy. Being satisfied with one's method and having confidence one is using one's method correctly are important for patient-centered principles and recommended strategies for contraceptive counseling practices.
Based on prior research showing that method type is associated with satisfaction, J.R. Steinberg et al examined whether method type was independently associated with contraceptive satisfaction and confidence in correct use and whether method type, satisfaction, and confidence were independently associated with switching intentions, after controlling for sociodemographics, perceived health status, frequency of religious attendance, frequency of sex with a male in the past 3 months, and past contraceptive behaviors and reproductive experiences.
Data were from a probability-based sample survey carried out in Delaware and Maryland in 2016 and 2017 among women ages 18 to 44. Women's current contraceptive methods were classified into 5 categories: coitally-dependent methods (barrier methods, withdrawal, and natural family planning); oral contraceptive pills, patches, and rings; injections; implants; and intrauterine contraception (IUC). Satisfaction, confidence, and switching intentions were dichotomized into being very versus less satisfied, being completely versus less confident, and having very low versus not very low switching intentions. Authors conducted binomial logistic regression to examine whether method type, satisfaction, and confidence were independently associated with having very low switching intentions, adjusting for a range of covariates including sociodemographics, perceived health, religious attendance frequency, sexual, contraceptive, and reproductive experiences, and state of residence (Maryland or Delaware).
Satisfaction with method- Satisfaction with current method was assessed with the question "How satisfied are you with your birth control method?" Women were coded into those who reported being very satisfied versus less (or not very) satisfied.
Confidence in correct use- Confidence in correct use was assessed with the question: "How confident are you that you have been using your method of birth control correctly for the past 3 months?" Women were coded into those who reported being completely confident versus less (or not very) confident.
Switching intentions-Switching intentions was measured with the following question: "Switching your current birth control method and using another method of birth control in the next 3 months is:"
- Twenty-one percent were using IUC (5.4% of the all contraceptive users reported using copper IUC), 3.5% were using an implant, 4.7% were using Depot Medroxyprogesterone Acetate, 45.1% were using pills, 0.2% were using patches, 3.1% were using rings, 17.3% were using condoms, and 5.1% were using a coitally-dependent method other than condoms
- Those using IUC were more likely to report being very satisfied (75.0%) and very unlikely (88.0%) to switch their method and those using coitally-dependent methods were more likely to report being less satisfied and having greater switching intentions (36.7% very satisfied and 43.2% very unlikely to switch)
- Women using pills, patches, or rings or coitally dependent methods were less likely to report being very satisfied with their method relative to women using IUC.
- Those using implants, pills, patches, or rings, and coitally-dependent methods relative to IUC were less likely to report very low switching intentions.
Authors found that using copper IUC was associated with very low switching intentions relative to using hormonal IUC. In contrast, those using coitally-based methods were less likely to report very low switching intentions relative to those using hormonal IUC. Those using implants and patches, rings, or pills were also less likely to report very low switching intentions relative to those using hormonal IUC but no longer at p < 0.05.
Among 1,077 women using reversible contraception, those using IUC relative to implants, pills, patches, or rings, and coitally-dependent methods were more likely to have very low switching intentions. Among all survey respondents, those who were very satisfied and those who were completely confident in correct use were also more likely to report very low switching intentions
After controlling for a range of covariates, authors found that being very satisfied with one's method, being completely confident in the correct use, and using IUC were independently associated with having very low switching intentions. These findings support the theory of planned behavior in that satisfaction and confidence in one's behavior (i.e., believing one is using contraception correctly) both were independently associated with switching intentions
There are a variety of reasons why IUC use might be associated with having very low switching intentions, independent of satisfaction and confidence in correct use. The single-item measure of global satisfaction, may miss important features of patient experience that reflect women's underlying attitudes towards or experiences with contraception – for example, ease of use, side effects, or concealability from partners. Alternatively, having very low switching intentions among IUC users may reflect perceived barriers to IUC removal. Such barriers might include perceived pressure to continue IUC that is exerted by national and state campaigns to increase IUC use, perceived difficulty in finding a provider to remove IUC, or experience with providers who discourage IUC removal either directly or implicitly. It is also possible that those using IUC do in fact have very low switching intentions and that is why they choose this long-acting method. Related, women may choose coitally-dependent methods with which they are not satisfied temporarily while they are deciding on another method.
Authors concluded, "We found that among a representative sample of reproductive aged women in Delaware and Maryland, those who were using IUC reported being very satisfied with their method relative to women using pills, patches, or rings and coitally-dependent methods. Across all users those who were very satisfied, those who were completely confident in correct use, and those using IUC were more likely to report very low switching intentions than those who were less satisfied, less confident, and using methods other than IUC."
Source: Julia R. Steinberga, Daniel Marthey, Liyang Xie, Michel Boudreaux; Contraception 104 (2021) 176–182