"She should support me, she's my doctor:" Patient perceptions of agency in contraceptive decision-making in the clinical encounter in Northern California.

IF 3.4 2区医学 Q1 DEMOGRAPHY Perspectives on Sexual and Reproductive Health Pub Date : 2023-06-01 Epub Date: 2023-05-22 DOI:10.1363/psrh.12226

Lavanya Rao, Corinne H Rocca, Isabel Muñoz, Brittany D Chambers, Sangita Devaskar, Ifeyinwa V Asiodu, Lisa Stern, Maya Blum, Alison B Comfort, Cynthia C Harper

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Abstract

Introduction: Agency in contraceptive decision-making is an essential aspect of reproductive autonomy. We conducted qualitative research to investigate what agency means to patients seeking contraceptive care to inform the development of a validated measure of this construct.

Methodology: We held four focus group discussions and seven interviews with sexually-active individuals assigned female at birth, ages 16-29 years, recruited from reproductive health clinics in Northern California. We explored experiences in contraceptive decision-making during the clinic visit. We coded data in ATLAS.ti and by hand, compared codes across three coders, and used thematic analysis to identify salient themes.

Results: The sample mean age was 21 years, with 17% of participants identifying as Asian, 23% as Black, 27% as Latinx, 17% as Multiracial/other, and 27% as white. Overall, participants reported active and engaged decision-making in their recent contraceptive visit but noted experiences that had undermined their agency in the past. They described how non-judgmental care allowed them to communicate openly, affirming their ability to make their own decisions. However, several mentioned how unexpected contraceptive side effects after the visit had reduced their sense of agency over their decision in retrospect. Several participants, including those who identified as Black, Latinx, and/or Asian, described prior experiences where pressure to use a contraceptive method had undermined their agency and where they had switched providers to regain agency over their contraceptive decisions.

Discussion: Most participants were aware of their agency during contraceptive visits and how it varied in different experiences with providers and the healthcare system. Patient perspectives can help to inform measurement development and ultimately the delivery of care that supports contraceptive agency.

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“她应该支持我，她是我的医生：”在北加利福尼亚州的临床实践中，患者对避孕决策机构的看法。

引言：避孕决策机构是生育自主的一个重要方面。我们进行了定性研究，以调查机构对寻求避孕护理的患者意味着什么，从而为开发这种结构的有效措施提供信息。方法：我们对16-29岁的性活跃者进行了四次焦点小组讨论和七次访谈年，从北加利福尼亚州的生殖健康诊所招募。我们在诊所访问期间探讨了避孕决策方面的经验。我们用ATLAS.ti和手工编码数据，比较三个编码器的代码，并使用主题分析来识别显著主题。结果：样本平均年龄为21岁年，17%的参与者认为自己是亚洲人，23%是黑人，27%是拉丁裔，17%是多种族/其他人，27%是白人。总的来说，参与者报告说，他们在最近的避孕访问中积极参与决策，但也指出了过去削弱其机构的经验。他们描述了非评判性的护理如何让他们能够公开交流，确认他们有能力做出自己的决定。然而，一些人提到，访问后意外的避孕副作用降低了他们对自己的决定的代理感。一些参与者，包括那些被认定为黑人、拉丁裔和/或亚裔的参与者，描述了他们之前的经历，即使用避孕方法的压力削弱了他们的代理权，以及他们更换了提供者以重新获得避孕决定的代理权。讨论：大多数参与者在避孕访问期间都知道自己的代理机构，以及在与提供者和医疗系统的不同经历中，代理机构是如何变化的。患者观点有助于为测量发展提供信息，并最终为支持避孕机构的护理提供信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Perspectives on Sexual and Reproductive Health Multiple-

CiteScore

5.10

自引率

3.40%

发文量

期刊介绍： Perspectives on Sexual and Reproductive Health provides the latest peer-reviewed, policy-relevant research and analysis on sexual and reproductive health and rights in the United States and other developed countries. For more than four decades, Perspectives has offered unique insights into how reproductive health issues relate to one another; how they are affected by policies and programs; and their implications for individuals and societies. Published four times a year, Perspectives on Sexual and Reproductive Health includes original research, special reports and commentaries on the latest developments in the field of sexual and reproductive health, as well as staff-written summaries of recent findings in the field.