title: New york city physicians' views of providing long-acting reversible contraception to adolescents.
abstract: OBJECTIVE
  Although the US adolescent pregnancy rate is high, use of the most effective reversible contraceptives-intrauterine devices (IUDs) and implantable contraception-is low. Increasing use of long-acting reversible contraception (LARC) could decrease adolescent pregnancy rates. We explored New York City primary care physicians' experiences, attitudes, and beliefs about counseling and provision of LARC to adolescents.
  
  
  METHODS
  We conducted in-depth telephone interviews with 28 family physicians, pediatricians, and obstetrician-gynecologists using an interview guide based on an implementation science theoretical framework. After an iterative coding and analytic process, findings were interpreted using the capability (knowledge and skills), opportunity (environmental factors), and motivation (attitudes and beliefs) conceptual model of behavior change.
  
  
  RESULTS
  Enablers to IUD counseling and provision include knowledge that nulliparous adolescents are appropriate IUD candidates (capability) and opportunity factors, such as (1) a clinical environment supportive of adolescent contraception, (2) IUD availability in clinic, and (3) the ability to insert IUDs or easy access to an someone who can. Factors enabling motivation include belief in the overall positive consequences of IUD use; this is particularly influenced by a physicians' perception of adolescents' risk of pregnancy and sexually transmitted disease. Physicians rarely counsel about implantable contraception because of knowledge gaps (capability) and limited access to the device (opportunity).
  
  
  CONCLUSIONS
  Knowledge, skills, clinical environment, and physician attitudes, all influence the likelihood a physician will counsel or insert LARC for adolescents. Interventions to increase adolescents' access to LARC in primary care must be tailored to individual clinical practice sites and practicing physicians, the methods must be made more affordable, and residency programs should offer up-to-date, evidence-based teaching.
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY 10461, USA. surubin@montefiore.org
authors.forename: Susan E
authors.initials: SE
authors.lastname: Rubin
authors.forename: Katie
authors.initials: K
authors.lastname: Davis
authors.forename: M Diane
authors.initials: MD
authors.lastname: McKee
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects / Q000592:standards; D004343:Drug Implants / Q000008:administration & dosage / Q000009:adverse effects / Q000592:standards; D005260:Female; D006176:Gynecology / Q000379:methods / Q000592:standards; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D007434:Intrauterine Devices / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D009519:New York City; D010372:Pediatrics / Q000592:standards; D010821:Physicians, Family / Q000523:psychology / Q000592:standards; D058007:Physicians, Primary Care / Q000523:psychology* / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D036301:Qualitative Research
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants