title: Acceptability of the vaginal diaphragm among current users.
abstract: BACKGROUND
  Interest in the diaphragm has been growing, in part because it is a female-controlled method that might protect against HIV and other sexually transmitted diseases (STDs). A better understanding of diaphragm acceptability is needed.
  
  
  METHODS
  In 2001-2002, female members of a managed care organization were interviewed by telephone. The 215 participants, aged 19-49, who reported diaphragm use during the past three months were asked about their experience with the method and background characteristics. Characteristics associated with women's satisfaction with and consistent use of the diaphragm were identified through multiple logistic regression analysis.
  
  
  RESULTS
  Most participants had a low risk for HIV and other STDs. The mean duration of diaphragm use was 8.5 years. Although only 42% of participants reported consistent use in the past three months, most were satisfied with the method (79%) and planned to use it at next vaginal intercourse (85%). Satisfied users had significantly higher diaphragm use self-efficacy and more positive perceptions of the method than those not satisfied. Consistent use was significantly associated with older age and having had some college education rather than none. More than half of women cited dissatisfaction with previous methods (72%) and provider recommendation (61%) as moderately to extremely important in their decision to begin diaphragm use. When asked what they would change about the diaphragm, 32% mentioned concerns related to inserting or removing it.
  
  
  CONCLUSIONS
  From an acceptability point of view, the diaphragm appears to be a viable candidate for a female-controlled method for prevention of HIV and other STDs. Our findings have important implications for the reintroduction of the traditional diaphragm and development of new diaphragm-like products.
authors.affiliation: Program Design and Evaluation Services, Multnomah County Health Department and Oregon Department of Human Services, Portland, OR, USA. julie.e.maher@state.or.us
authors.forename: Julie E
authors.initials: JE
authors.lastname: Maher
authors.forename: S Marie
authors.initials: SM
authors.lastname: Harvey
authors.forename: Sheryl Thorburn
authors.initials: ST
authors.lastname: Bird
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Stevens
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Beckman
mesh_terms: D000328:Adult; D001294:Attitude to Health; D003268:Contraception Behavior / Q000523:psychology*; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015205:Northwestern United States; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012307:Risk Factors; D012725:Sexual Behavior / Q000523:psychology; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D011795:Surveys and Questionnaires; D016387:Women's Health