title: Interdependent Barriers to Providing Adolescents with Long-Acting Reversible Contraception: Qualitative Insights from Providers.
abstract: OBJECTIVE
  Long-acting reversible contraceptive (LARC) methods are the most effective form of reversible contraception but are underutilized by adolescents. The purpose of this study was to identify the context-specific barriers to providing adolescents with LARC that are experienced by pediatricians, family medicine physicians, and advanced practice nurses (APNs).
  
  
  METHODS
  Pediatricians, family medicine providers, and APNs (n = 16) who care for adolescents participated in semistructured qualitative interviews. Interview data were analyzed using a modified grounded theory approach.
  
  
  METHODS
  Pediatricians, family medicine physicians, and APNs self-reported attitudes and practices regarding LARC provision to adolescents.
  
  
  RESULTS
  Provider confidence in LARC, patient-centered counseling on LARC, and instrumental supports for LARC all work interdependently either in support of or in opposition to provision of LARC to adolescents. Low provider confidence in LARC for adolescents was characterized by confusion about LARC eligibility criteria and perceptions of LARC insertion as traumatic for adolescents. Patient-centered counseling on LARC required providers' ability to elicit patient priorities, highlight the advantages of LARC over other methods, and address patients' concerns about these methods. Instrumental support for LARC included provider training on LARC, access to and financial support for LARC devices, and opportunity to practice LARC insertion and counseling skills.
  
  
  CONCLUSIONS
  Although none of the identified essential components of LARC provision to adolescents exist in isolation, instrumental support like provider training on LARC and access to LARC devices have the most fundamental effect on the other components and on providers' attitudes and practices regarding LARC for adolescents.
authors: Community Health Sciences Division, School of Public Health, University of Illinois-Chicago, Chicago, Illinois. Electronic address: mmurph6@uic.edu.
authors: Molly K
authors: MK
authors: Murphy
authors: Department of Obstetrics and Gynecology, University of Illinois-Chicago, Chicago, Illinois.
authors: Cindy
authors: C
authors: Stoffel
authors: Department of Obstetrics and Gynecology, University of Illinois-Chicago, Chicago, Illinois.
authors: Meghan
authors: M
authors: Nolan
authors: Department of Obstetrics and Gynecology, University of Illinois-Chicago, Chicago, Illinois.
authors: Sadia
authors: S
authors: Haider
mesh_terms: D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000379:methods*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003376:Counseling; D003695:Delivery of Health Care; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007434:Intrauterine Devices / Q000706:statistics & numerical data; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D011795:Surveys and Questionnaires
chemical_list: D003271:Contraceptive Agents, Female
keywords: Adolescents; Contraception; Long-acting reversible contraception; Qualitative; Teen pregnancy; Unintended pregnancy