title: Counseling for IUDs and implants: are health educators and clinicians on the same page?
abstract: BACKGROUND
  Low knowledge of long-acting reversible contraceptives (LARC) and restrictive counseling practices have been documented among contraceptive care clinicians. However, little is known about health educators' counseling on LARC, how their practices compare with clinicians' and their specific training needs.
  
  
  METHODS
  A survey conducted in 2011-2012 assessed knowledge and practices related to LARC counseling and provision among 410 staff at 40 Planned Parenthood clinics. Clinicians' and health educators' knowledge and practices were compared via chi-square tests; use of evidence-based criteria was assessed in multivariable logistic regression analyses.
  
  
  RESULTS
  At least half of both types of staff routinely discussed LARC with clients, and nearly all considered the methods safe. Health educators considered a smaller proportion of clients candidates for LARC than did clinicians (57% vs. 77%), and they were less likely to consider IUDs for teenagers (79% vs. 96%), nulliparous women (82% vs. 98%) and unmarried clients (90% vs. 99%). In a multivariable model, health educators were less likely than clinicians to counsel clients using the least restrictive evidence-based criteria (odds ratio, 0.1). Sixty-four percent of health educators and 40% of clinicians desired additional LARC training.
  
  
  CONCLUSIONS
  Even in clinics that specialize in reproductive health care, health educators are less likely than clinicians to apply current evidence-based criteria in counseling about LARC. To provide evidence-based contraceptive counseling, health educators need training on LARC eligibility and indications.
authors: Kirsten M.J. Thompson is project director, J. Joseph Speidel is professor and Cynthia C. Harper is associate professor, all at the Bixby Center for Global Reproductive Health, University of California, San Francisco.
authors: Kirsten M J
authors: KM
authors: Thompson
authors: Lisa
authors: L
authors: Stern
authors: Marsha
authors: M
authors: Gelt
authors: J Joseph
authors: JJ
authors: Speidel
authors: Cynthia C
authors: CC
authors: Harper
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003267:Contraception / Q000379:methods*; D003270:Contraceptive Agents; D003430:Cross-Sectional Studies; D003692:Delayed-Action Preparations; D037001:Directive Counseling; D005193:Family Planning Services; D005260:Female; D040441:Health Educators; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007434:Intrauterine Devices; D008297:Male; D008875:Middle Aged; D009721:Nurse Midwives; D009722:Nurse Practitioners; D010823:Physician Assistants; D010820:Physicians; D055815:Young Adult
chemical_list: D003270:Contraceptive Agents; D003692:Delayed-Action Preparations