title: Pediatricians' Attitudes and Beliefs about Long-Acting Reversible Contraceptives Influence Counseling.
abstract: OBJECTIVE
  Adolescents are at high risk for unintended pregnancy. Because of pediatricians' potential role in contraceptive counseling, understanding their attitudes and beliefs and counseling practices about use of long-acting reversible contraceptives (LARC; ie, etonogestrel implant and intrauterine devices [IUDs]) is vital. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We interviewed primary care pediatricians (N = 23) in a Midwestern city in June-August 2014. We transcribed the interviews, developed a coding schema, and analyzed these qualitative data using a priori and open coding of transcripts.
  
  
  RESULTS
  Few pediatricians had favorable views on adolescent IUD use and most did not include IUDs in routine contraception counseling. Pediatricians perceived IUDs to impose significant risks for adverse reproductive outcomes and to be poorly tolerated by adolescents. Poor and/or outdated knowledge influenced inaccurate beliefs and unsupportive attitudes. Whereas some pediatricians were advocates for adolescent use of IUDs, many others had concerns that IUDs were not appropriate and not favored by adolescents. In contrast, participants viewed the etonogestrel implant more favorably and often included it in routine counseling. Some pediatricians focused on the familiar and readily available methods (injectable and oral contraceptives) or assumed patients had predetermined expectations for those methods. Time spent counseling on LARC was also perceived as a barrier. Pediatricians described how education and increased familiarity with LARC changed viewpoints.
  
  
  CONCLUSIONS
  A variety of beliefs and attitudes, as well as factors such as time and personal habits, influence pediatricians' contraceptive counseling practices. Until knowledge deficits are addressed, uninformed viewpoints and unfavorable attitudes will limit adolescents' access to LARC, especially IUDs.
authors.affiliation: Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio. Electronic address: elise.berlan@nationwidechildrens.org.
authors.forename: Elise D
authors.initials: ED
authors.lastname: Berlan
authors.affiliation: Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Pritt
authors.affiliation: Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio; Division of Infectious Diseases, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Alison H
authors.initials: AH
authors.lastname: Norris
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003267:Contraception / Q000379:methods / Q000523:psychology*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects; D003376:Counseling / Q000379:methods*; D017135:Desogestrel / Q000008:administration & dosage / Q000009:adverse effects; D005193:Family Planning Services; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007434:Intrauterine Devices / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States; D000072143:Pediatricians / Q000523:psychology*; D010819:Physician's Role / Q000523:psychology*; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control / Q000523:psychology
chemical_list: D003271:Contraceptive Agents, Female; C044815:etonogestrel; D017135:Desogestrel
keywords: Adolescents; Contraception; Long-acting reversible contraception; Pediatrics; Qualitative; Teen pregnancy