Context

Few U.S. women use an IUD, despite the method's efficacy and ease of use. While studies have found that misconceptions about IUDs are prevalent, few have examined the influence of women's social networks on perceptions of the method.

Methods

Twenty-four interviews and three focus groups (comprising 14 participants) were conducted in 2013 with a diverse sample of women aged 15-45 recruited from family planning clinics and the community in San Francisco. Half of participants had used IUDs. Women were asked about their social communication concerning contraceptives, particularly IUDs, and about the content of the information they had received or given. Transcripts were analyzed using a modified grounded theory approach to identify themes of interest.

Results

Women reported that communication with female friends and family members was a valued means of obtaining information about contraceptives, and that negative information (which often was incorrect) was more prevalent and memorable than positive information in such communication. Women heard about negative experiences with IUDs from social contacts and television commercials; clinicians were a major source of positive information. Women who had never used IUDs expressed interest in learning about potential side effects and how IUDs feel, while users reported emphasizing to friends and family the method's efficacy and ease of use.

Conclusions

Misinformation and negative information about IUDs are prevalent in social communication, and the information transmitted through social networks differs from the information never-users wish to receive. Findings support the creation of peer-led interventions to encourage IUD users to share positive personal experiences and evidence-based information.

Context

IUDs are infrequently used in the United States. Assessing how counseling about this method is delivered can help identify barriers to IUD use that might be overcome by improving services.

Methods

A sample of 342 family planning visits at six clinics in the San Francisco Bay Area in 2009-2012 were audio-recorded, and patients completed surveys both before and after their visits. Descriptive quantitative analyses of counseling were performed, and correlates of IUDs' being mentioned during counseling were investigated using logistic regression. Qualitative analyses investigated the counseling women received about IUDs generally (in a subset of 42 visits), as well as counseling for women who already had an IUD in place (13 visits) or who felt their provider inappropriately expressed a preference for IUDs (five visits).

Results

IUDs were mentioned in 75% of visits. Patient-initiated mention of IUDs was more likely in visits by women aged 35 or older than in those by women younger than 20 (odds ratio, 6.4); provider-initiated discussion of this method was less common if the provider was older than 55 than if he or she was younger than 46 (0.3). Providers more often discussed potential adverse effects of IUD use than benefits; counseling often was noninteractive and did not address how patient preferences related to characteristics of IUDs. Counseling was frequently fragmented by the need for return visits or referral elsewhere for insertion.

Conclusions

IUD counseling may be improved by enhancing comprehensiveness and patient-centeredness, and by decreasing fragmentation of care.