title: Repeat pregnancy prevention self-efficacy in adolescents:  associations with provider communication, provider type, and depression.
abstract: OBJECTIVE
  Among adolescent mothers, pregnancy prevention self-efficacy developed during pregnancy may predict the use of contraception following delivery. Communication between patients and their primary care providers (PCPs) is important for adherence to physician recommendations and may be associated with pregnancy prevention self-efficacy. Depression, which is common among adolescent mothers, has been associated with poor self-efficacy. The associations among pregnancy prevention self-efficacy, provider communication, provider type (PCP vs others), and depression are unclear. The objectives of the study were to determine the association of positive provider communication with pregnancy prevention self-efficacy, whether provider type or depression is associated with positive provider communication, and whether the association between provider communication and pregnancy prevention self-efficacy varies by provider type and depression.
  
  
  METHODS
  Cross-sectional study of 164 third trimester Baltimore adolescents measuring pregnancy prevention self-efficacy, perceptions of the quality of provider communication (Ambulatory Care Experiences Survey), provider type, and depressive symptoms.
  
  
  RESULTS
  Of 164 pregnant teens, 79% reported pregnancy prevention self-efficacy, 72% had a specific PCP, and 17% scored positive for depression. Positive provider communication was associated with pregnancy prevention self-efficacy (odds ratio 1.25; P = 0.04). Adolescents with PCPs had significantly higher communication scores (β 0.90; P = 0.001). Depressed adolescents had significantly lower communication scores (β -0.74; P = 0.03). The association between positive provider communication and self-efficacy was significant only for adolescents who reported having a PCP (P = 0.04) and those who were not depressed (P = 0.05).
  
  
  CONCLUSIONS
  Having a PCP and favorable perceptions of provider communication are important for pregnancy prevention self-efficacy among adolescents. Depression negatively affects perceptions of provider communication, which may limit self-efficacy.
authors.affiliation: Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York 10451, USA. dcarvaja@montefiore.org
authors.forename: Diana N
authors.initials: DN
authors.lastname: Carvajal
authors.forename: Lori
authors.initials: L
authors.lastname: Burrell
authors.forename: Anne K
authors.initials: AK
authors.lastname: Duggan
authors.forename: Beth
authors.initials: B
authors.lastname: Barnet
mesh_terms: D000293:Adolescent; D002648:Child; D003267:Contraception / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016014:Linear Models; D016015:Logistic Models; D010349:Patient Compliance; D010817:Physician-Patient Relations; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control* / Q000523:psychology; D011320:Primary Health Care; D020377:Self Efficacy; D055815:Young Adult