title: Influences on women's decision making about intrauterine device use in Madagascar.
abstract: OBJECTIVE
  We explored influences on decision making about intrauterine device (IUD) use among women in the Women's Health Project (WHP), managed by Population Services International in Madagascar.
  
  
  METHODS
  We conducted six small group photonarrative discussions (n=18 individuals) and 12 individual in-depth interviews with women who were IUD users and nonusers. All participants had had contact with WHP counselors in three sites in Madagascar. Data analysis involved creating summaries of each transcript, coding in Atlas.ti and then synthesizing findings in a conceptual model.
  
  
  RESULTS
  We identified three stages of women's decision making about IUD use, and specific forms of social support that seemed helpful at each stage. During the first stage, receiving correct information from a trusted source such as a counselor conveys IUD benefits and corrects misinformation, but lingering fears about the method often appeared to delay method adoption among interested women. During the second stage, hearing testimony from satisfied users and receiving ongoing emotional support appeared to help alleviate these fears. During the third stage, accompaniment by a counselor or peer seemed to help some women gain confidence to go to the clinic to receive the IUD.
  
  
  CONCLUSIONS
  Identifying and supplying the types of social support women find helpful at different stages of the decision-making process could help program managers better respond to women's staged decision-making process about IUD use.
  
  
  CONCLUSIONS
  This qualitative study suggests that women in Madagascar perceive multiple IUD benefits but also fear the method even after misinformation is corrected, leading to a staged decision-making process about IUD use. Programs should identify and supply the types of social support that women find helpful at each stage of decision making.
authors: Department of Health Behavior, UNC Gillings School of Global Public Health. Electronic address: agottert@live.unc.edu.
authors: Ann
authors: A
authors: Gottert
authors: Marie Stopes International, London, UK.
authors: Karin
authors: K
authors: Jacquin
authors: Population Services International, Madagascar.
authors: Bakoly
authors: B
authors: Rahaivondrafahitra
authors: Department of Health Behavior, UNC Gillings School of Global Public Health.
authors: Kathryn
authors: K
authors: Moracco
authors: Department of Health Behavior, UNC Gillings School of Global Public Health.
authors: Suzanne
authors: S
authors: Maman
mesh_terms: D000328:Adult; D003142:Communication; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007434:Intrauterine Devices; D008270:Madagascar; D057240:Patient Preference; D036301:Qualitative Research; D012944:Social Support; D055815:Young Adult
keywords: Counseling; Family planning; IUD; Madagascar; Social support