IUD-related knowledge, attitudes and practices among Navajo Area Indian Health Service providers.
BACKGROUND
The IUD once accounted for about half of contraceptive use among Navajo women but is now little used in this population, which has a high rate of unintended pregnancy. Identifying barriers to use--including those stemming from providers' IUD-related knowledge, attitudes and practices--could help expand use of the method.


METHODS
In 2000, 107 Navajo Area Indian Health Service providers who offer contraceptive services completed a mailed survey. Responses of women's health providers and other types of providers were compared, using the Cochran-Mantel-Haenszel method.


RESULTS
Overall, 69-78% of providers had good factual knowledge about the IUD and felt adequately prepared to insert a device or counsel women about it; considerably larger proportions of women's health providers than of others felt able to counsel about and insert IUDs. Sixty-five percent of providers (88% of women's health providers and 50% of others) currently inserted IUDs, and only 8% (none of them women's health providers) never recommended the method. The main reasons providers cited for not recommending the IUD were concerns about its safety and about side effects (mentioned by 69% and 44%, respectively); these concerns did not differ by provider type.


CONCLUSIONS
Provider education and training should focus on insertion techniques and on the safety of available IUDs. Training should be targeted not only to women's health providers, but to family practice physicians, nurse practitioners and other providers who offer family planning counseling and services.
Espey
Eve
E
Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, USA. eespey@salud.unm.edu
Ogburn
Tony
T
Espey
David
D
Etsitty
Virgil
V
D002983:Clinical Competence; D003268:Contraception Behavior / Q000208:ethnology*; D005194:Family Practice / Q000592:standards; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006303:Health Services, Indigenous / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007198:Indians, North American; D007434:Intrauterine Devices / Q000706:statistics & numerical data*; D008297:Male; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D011322:Primary Prevention / Q000379:methods / Q000592:standards; D034121:Reproductive Health Services / Q000592:standards / Q000706:statistics & numerical data*; D014481:United States; D016549:United States Indian Health Service / Q000592:standards