title: "I don't know enough to feel comfortable using them:" Women's knowledge of and perceived barriers to long-acting reversible contraceptives on a college campus.
abstract: To assess multiple dimensions of long-acting reversible contraception (LARC) knowledge and perceived multi-level barriers to LARC use among a sample of college women.
  
  
  
  We conducted an Internet-based study of 1982 female undergraduates at a large mid-western university. Our 55-item survey used a multi-level framework to measure young women's understanding of, experiences with intrauterine devices (IUD) and implants and their perceived barriers to LARC at individual, health systems and community levels. The survey included a 20-item knowledge scale. We estimated and compared LARC knowledge scores and barriers using descriptive, bivariate and linear regression statistics.
  
  
  
  Few college women had used (5%) or heard of (22%) LARC, and most self-reported "little" or "no" knowledge of IUDs (79%) and implants (88%). Women answered 50% of LARC knowledge items correctly (mean 10.4, range 0-20), and scores differed across sociodemographic groups (p values<.04). Factors associated with scores in multivariable models included race/ethnicity, program year, sorority participation, religious affiliation and service attendance, employment status, sexual orientation and contraceptive history. Perceived barriers to IUDs included the following: not wanting a foreign object in body (44%), not knowing enough about the method (42%), preferring a "controllable" method (42%), cost (27%), and not being in a long-term relationship (23%). Implant results were similar. "Not knowing enough" was women's primary reason for IUD (18%) and implant (22%) nonuse.
  
  
  
  Lack of knowledge (both perceived and actual) was the most common barrier among many perceived individual-, systems- and community-level factors precluding these college women's LARC use. Findings can inform innovative, multi-level interventions to improve understanding, acceptability and uptake of LARC on campuses.
  
  
  
  Lack of knowledge of IUDs and implants served as a primary barrier to highly effective contraceptive use among these college women. Comprehensive, patient-centered and multi-level educational public health strategies are needed to promote positive campus climates around LARC and improve family planning outcomes among this substantial reproductive-aged population.
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, GCR 560, Atlanta, GA 30322, USA. Electronic address: kelli.s.hall@emory.edu.
authors.forename: Kelli Stidham
authors.initials: KS
authors.lastname: Hall
authors.affiliation: Population Studies Center, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ela
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Zochowski
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Caldwell
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Moniz
authors.affiliation: University Health Service, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: McAndrew
authors.affiliation: University Health Service, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Monique
authors.initials: M
authors.lastname: Steel
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Sneha
authors.initials: S
authors.lastname: Challa
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Dalton
authors.affiliation: University Health Service, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Ernst
mesh_terms: D000293:Adolescent; D003267:Contraception / Q000379:methods / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007434:Intrauterine Devices / Q000706:statistics & numerical data*; D016014:Linear Models; D015999:Multivariate Analysis; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D014481:United States; D014495:Universities; D055815:Young Adult
keywords: Barriers; College; Implant; Intrauterine device; Knowledge; Long-acting reversible contraception