title: The Role of Patient Activation in Contraceptive Use.
abstract: OBJECTIVE
  Many unintended pregnancies occur due to to contraceptive misuse and nonuse, which is partly due to to lack of knowledge and low self-efficacy related to contraception. We conducted an exploratory, cross-sectional study among low-income women to examine the relationship between knowledge, skills, and confidence in managing one's health, measured using the Patient Activation Measure (PAM) and factors that influence contraceptive use.
  
  
  METHODS
  A survey and chart review were conducted among 18- to 45-year-old women from a community health center in Chicago, Illinois, to measure the relationship between activation, self-confidence in avoiding pregnancy, contraception use, and contraceptive counseling. Associations between PAM and outcomes were evaluated using the χ(2) test and adjusted logistic regression models.
  
  
  RESULTS
  Among 112 participants (61% Latina, 15% Black, 14% White), we found no differences in PAM by age, race/ethnicity, or parity. Women with higher PAM were more likely to be confident they could avoid pregnancy compared with women with lower PAM (50% vs. 7%; p = .02). Higher PAM remained a significant predictor for self-confidence after risk adjustment (odds ratio, 3.13; 95% CI, 1.11-8.78; p = .031). Greater confidence in avoiding pregnancy was associated with using a moderately or highly effective contraceptive method (43% vs. 14%; p = .047). Women with lower PAM were less likely to receive contraceptive counseling in the prior month (0% vs. 57%; p < .01).
  
  
  CONCLUSIONS
  Patient activation may be an important construct for understanding factors that influence women's contraceptive use, including self-confidence in avoiding pregnancy until it is desired and receiving contraceptive services in primary care.
authors.affiliation: Department of Family Medicine, NorthShore University HealthSystem, Evanston, Illinois; Department of Family Medicine, University of Chicago, Chicago, Illinois. Electronic address: Jbello-kottenstette@northshore.org.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Bello
authors.affiliation: Department of Family Medicine, NorthShore University HealthSystem, Evanston, Illinois.
authors.forename: Brittany
authors.initials: B
authors.lastname: Lapin
authors.affiliation: Department of Family Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Poston
authors.affiliation: Erie Family Health Center, Chicago, Illinois.
authors.forename: Meredith
authors.initials: M
authors.lastname: Hirshfeld
authors.affiliation: Department of Family Medicine, NorthShore University HealthSystem, Evanston, Illinois.
authors.forename: Allison
authors.initials: A
authors.lastname: Hosack
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D002641:Chicago; D003151:Community Health Centers; D003267:Contraception / Q000706:statistics & numerical data; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D010358:Patient Participation; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult