Study Examines Knowledge, Attitudes About IUDs Among Staff at School-Based Health Centers

October 25, 2012 — Summary of "Knowledge and Likelihood to Recommend Intrauterine Devices for Adolescents Among School-based Health Center Providers," Kohn et al., Journal of Adolescent Health, March 14, 2012.

Although recent research suggests that declines in the U.S. teenage pregnancy rate from 1995 to 2002 can be attributed to increased contraceptive use, teens mostly rely on contraceptive methods -- such as condoms and oral contraceptives -- with low adherence and continuation rates, which can put them at risk for unintended pregnancies.

Increasing adolescents' use of long-acting reversible contraceptives, such as intrauterine devices, could help accelerate reductions in teen pregnancies, according to a study led by Julia Kohn of the New York City Bureau of Maternal, Infant and Reproductive Health. IUDs are safe for use in adolescents, have lower failure rates than methods that require daily adherence and have high continuation rates.

Kohn and colleagues developed a study to examine knowledge and attitudes about IUDs among providers who primarily serve adolescents.

Methods

The researchers administered a 36-item survey before three meetings of staff members from school-based health centers (SBHCs) in New York City that were participating in a new reproductive health initiative. Of the 41 SBHCs in the city, at least one staff member from 37 of the centers attended the meetings, which were about the latest research on IUDs.

In addition to demographic-related questions, the surveys included seven items about respondents' knowledge of IUDs and nine items in which they rated their likelihood of recommending an IUD to various hypothetical patients who did not have contraindications for the method. Clinicians who completed the survey also answered seven questions about their experience inserting IUDs.

A total of 69 clinicians, such as nurse practitioners and physicians, and 93 nonclinicians, such as social workers, health educators, medical assistants and administrative staff, completed the surveys.

Results

Ninety-four percent of respondents answered correctly that currently available IUDs are safe, and 86% correctly responded that IUDs are appropriate for patients with no previous pregnancies.

There were no significant differences between clinicians and nonclinicians in terms of knowledge about IUDs, except in two areas: Ninety-four percent of clinicians knew that IUDs can be used in nulliparous patients, compared with 81% of nonclinicians, and 83% of clinicians knew that IUDs do not increase the risk of cervical dysplasia, compared with 57% of nonclinicians.

In their responses about the likelihood of recommending IUDs, clinicians generally were not more likely than nonclinicians to recommend the devices, except for three types of patients: unmarried patients, those younger than age 20 and those with abnormal Pap tests.

Overall, 65% of respondents said they would recommend an IUD to a patient who was unmarried, 58% would recommend one for a patient with no previous pregnancies and 55% would recommend one for a patient younger than age 20. Most respondents would not recommend an IUD for a patient who had a history of a sexually transmitted infection or pelvic inflammatory disease, was not in a monogamous relationship, or had a history of ectopic pregnancy.

Generally, respondents with greater overall knowledge of IUDs were more likely than respondents with less knowledge to recommend the devices. Notably, however, while 77% of respondents indicated that IUDs are safe for adolescents, 18% of those same respondents were somewhat or very unlikely to recommend one for a patient under age 20. Similarly, while 86% of respondents knew that IUDs are appropriate for nulliparous women, 25% of those respondents were unlikely to recommend one for a patient with no previous pregnancies.

Discussion

Although knowledge about IUDs was high overall, the study identified "several important misconceptions" among respondents about the risks of IUDs and when they should be inserted. While most clinicians said they would be comfortable discussing an IUD with a patient, fewer were likely to recommend one, including for women with characteristics that were not contraindications for IUD use.

The findings "suggest several important barriers to provider recommendation of IUDs, including lack of knowledge about the method itself and misinformation regarding patient eligibility," the researchers wrote. The results also suggest "providers are likely to be overly restrictive in their screening and recommendation of IUDs to adolescents," which could preclude more widespread use of the method among a population with a high risk of unintended pregnancy.

The researchers called for greater provider education, particularly to address the areas of misconceptions identified in the study. However, they noted that their findings suggest that increased knowledge "may be insufficient alone to increase the provision of IUDs to adolescents," given the "[a]pparent contradictions between knowledge and likelihood to recommend IUDs." The researchers recommended further research to explore reasons behind providers' unwillingness to recommend IUDs for many teen patients.