title: Providers' perspectives on challenges to contraceptive counseling in primary care settings.
abstract: BACKGROUND
  Although three quarters of reproductive-age women see a health provider annually, less than half receive recommended contraceptive counseling services. We sought to explore providers' perspectives on the challenges to contraceptive counseling in primary care clinics to develop strategies to improve counseling services.
  
  
  METHODS
  A qualitative, focus group (n = 8) study was conducted in November and December 2007; 48 of 90 providers practicing in four primary care clinics at the University of Pittsburgh Medical Center participated. Providers included physicians, nurses, and pharmacists working in these clinics' multidisciplinary teams. Discussions explored perceived barriers to the provision of counseling services. All groups were audiorecorded, transcribed, and entered into Atlas.Ti, a qualitative data management software. The data were analyzed using a grounded theory approach to content analysis.
  
  
  RESULTS
  Perceived patient, provider, and health system barriers to contraceptive counseling were identified. Perceived patient barriers included infrequent sexual activity, familiarity with a limited number of methods, desire for pregnancy despite medical contraindications, and religious beliefs. Provider barriers included lack of knowledge, training, and comfort; assumptions about patient pregnancy risk; negative beliefs about contraceptive methods; reliance on patients to initiate discussions; and limited communication between primary care providers (PCPs) and subspecialists. Health system barriers included limited time and competing medical priorities.
  
  
  CONCLUSIONS
  PCPs vary widely in their knowledge, perceived competence, and comfort in providing contraceptive counseling. General efforts to improve integration of contraceptive counseling into primary care services in addition to electronic reminders and efficient delivery of contraceptive information are needed.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213-3180, USA. aakers@mail.magee.edu
authors.forename: Aletha Y
authors.initials: AY
authors.lastname: Akers
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Gold
authors.forename: Sonya
authors.initials: S
authors.lastname: Borrero
authors.forename: Aimee
authors.initials: A
authors.lastname: Santucci
authors.forename: Eleanor B
authors.initials: EB
authors.lastname: Schwarz
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003268:Contraception Behavior; D003376:Counseling; D005193:Family Planning Services; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care; D011247:Pregnancy; D011320:Primary Health Care; D055815:Young Adult