A Qualitative Study of Factors That Influence Contraceptive Choice among Adolescent School-Based Health Center Patients

Study ObjectiveLong-acting reversible contraceptive (LARC) methods can prevent teen pregnancy yet remain underutilized by adolescents in the United States. Pediatric providers are well positioned to discuss LARCs with adolescents, but little is known about how counseling should occur in pediatric primary care settings. We explored adolescent womens' attitudes and experiences with LARCs to inform the development of adolescent-centered LARC counseling strategies.DesignQualitative analysis of one-on-one interviews.SettingParticipants were recruited from 2 urban school-based, primary care centers.ParticipantsThirty adolescent women aged 14-18 years, diverse in race/ethnicity, and sexual experience.InterventionsInterviews were audio-recorded, transcribed, and coded using inductive and deductive coding.Main Outcome MeasureMajor themes were identified to integrate LARC-specific adolescent preferences into existing counseling approaches.ResultsParticipants (mean age, 16.2 years; range, 14-18 years) represented a diverse range of racial and/or ethnic identities. Half (15/30) were sexually active and 17% (5/30) reported current or past LARC use. Five themes emerged regarding key factors that influence LARC choice, including: (1) strong preferences about device-specific characteristics; (2) previous exposure to information about LARCs from peers, family members, or health counseling sessions; (3) knowledge gaps about LARC methods that affect informed decision-making; (4) personal circumstances or experiences that motivate a desire for effective and/or long-acting contraception; and (5) environmental constraints and supports that might influence adolescent access to LARCs.ConclusionWe identified 5 factors that influence LARC choice among adolescent women and propose a framework for incorporating these factors into contraceptive counseling services in pediatric primary care settings.