title: Examining the diverse perspectives of nurse practitioners regarding obstacles to diaphragm prescription: a latent class analysis.
abstract: BACKGROUND
  The diaphragm is receiving renewed attention not only for its dual method potential but also because of improved design. To facilitate method re-introduction, we examined what providers think about this female-controlled barrier contraceptive.
  
  
  METHODS
  A questionnaire administered to 450 women's health nurse practitioners (NPs) asked about their practice experience and issues concerning diaphragm use. Latent class analysis (LCA) was used to identify different groups of providers, based on patterns of perceptions regarding various potential obstacles to diaphragm use. Provider profiles were further described in terms of individual and practice characteristics.
  
  
  RESULTS
  The survey achieved a 47% response rate (n = 214). Respondents saw, on average, 31 family planning patients/week; 87% had fitted a diaphragm, although only 40% had done so in the previous year. Three groups holding significantly different perceptions of obstacles to diaphragm prescription were identified. Group 1 (13% of respondents), with more practice experience in delivering women's healthcare and fitting diaphragms, considered all obstacles relatively inconsequential. Group 2 (40%) had comparatively minor concerns, whereas Group 3 (47%) perceived all issues as major obstacles. All groups stressed the diaphragm's limited promotion, and for 87% of the respondents, concerns about effectiveness and nonfamiliarity with the method also assumed more salience.
  
  
  CONCLUSIONS
  Emerging statistical modeling approaches that go beyond standard aggregate analyses helped identify three groups of women's health nurse practitioners. By considering their diverse perceptions of potential obstacles to diaphragm use, strategies aimed at changing provider behaviors may be developed to reverse declining prescribing rates and retain the diaphragm as a viable reproductive healthcare option for women.
authors.affiliation: Maternal and Child Health Concentration, Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama 35294-0022, USA. andrzej@uab.edu
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kulczycki
authors.forename: Haiyan
authors.initials: H
authors.lastname: Qu
authors.forename: Penelope M
authors.initials: PM
authors.lastname: Bosarge
authors.forename: Richard M
authors.initials: RM
authors.lastname: Shewchuk
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D009722:Nurse Practitioners / Q000145:classification / Q000523:psychology*; D057184:Practice Patterns, Nurses'; D011795:Surveys and Questionnaires