ABSTRACT
Study Objective
Adolescents use long-acting reversible contraceptive (LARC) methods less than adults.
Practices that specialize in adolescent medicine, including Adolescent Medicine (AM)
and Pediatric and Adolescent Gynecology (PAG), may be well positioned to help improve
adolescent access to these methods. We describe administrative and system-level barriers
encountered when implementing LARCs for adolescents and strategies that practices
have successfully used to address these barriers.
Design/Setting/Participants
We conducted a qualitative study with physicians and staff at AM and PAG practices
that provide LARCs to adolescents.
Interventions
Semi-structured telephone interviews
Main Outcome Measures
Interview guides were based on the Consolidated Framework for Implementation Research
(CFIR), an implementation science methodology designed to understand the following
aspects of settings adopting new practices: innovation characteristics, external environment,
institutional and practice settings, the stakeholders involved, and the implementation
process.
Results
Seventeen interviews were performed. When examining administrative and system-level
challenges encountered by interviewees, the four CFIR constructs identified most frequently
were cost, readiness for implementation–available resources, planning, and engaging.
Interviewees shared strategies used to overcome these common barriers, including for
billing and working with insurance companies, space and equipment needed to introduce
LARCs, scheduling and use of telemedicine, and staff training and engagement.
Conclusion
Sites used many strategies to address these common challenges to implementation. Examples
could help with implementation of LARC provision in practices serving adolescent populations.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric and Adolescent GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Committee on Adolescent Health Care: Adolescent pregnancy, contraception, and sexual activity. Committee Opinion No 699. The American College of Obstetricians and Gynecologists, 2017
- Declines in unintended pregnancy in the United States, 2008-2011.N Engl J Med. 2016; 374: 843-852
- Committee opinion no. 735: adolescents and long-acting reversible contraception: implants and intrauterine devices.Obstet Gynecol. 2018; 131: e130-e139
- Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2006-2010 National Survey of Family Growth.Vital Health Stat. 2011; 23: 1-35
- Long-acting reversible contraception: a practical solution to reduce unintended pregnancy.Minerva Ginecol. 2013; 65: 271-277
- Effectiveness of long-acting reversible contraception.N Engl J Med. 2012; 366: 1998-2007
- Policy Statement: contraception for adolescents.Pediatrics. 2014; 134: e1244
- Provision of contraception in New York City school-based health centers: impact on teenage pregnancy and avoided costs, 2008 –2017.Perspect Sec Reprod Health. 2019; 51: 201-209
- Pediatric practice transformation and long–acting reversible contraception (LARC) use in adolescents.Acad Pediatr. 2022; 22: 296-304
- Familiarity with long-acting reversible contraceptives among obstetrics and gynecology, family medicine, and pediatrics residents: results of a 2015 national survey and implications for contraceptive provision for adolescents.J Pediatr Adolesc Gynecol. 2018; 31: 40-44
- Health care barriers to provision of long-acting reversible.contraception in Wisconsin. Wis Med J. 2018; 117: 149-155
- Pediatricians knowledge and practices related to long-acting reversible contraceptives for adolescent girls.J Pediatr Adolesc Gynecol. 2018; 31: 394
- Interdependent barriers to providing adolescents with long-acting reversible contraception: qualitative insights from providers.J Pediatr Adolesc Gynecol. 2016; 29: 436-442
- Can pediatricians provide long-acting reversible contraception?.J Pediatr Adolesc Gynecol. 2019; 32: 39-43
- Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science.Implement Sci. 2009; 4: 50
- Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory.3rd ed. Sage, Thousand Oaks, CA2008
- Three approaches to qualitative content analysis.Qual Health Res. 2005; 15: 1277-1288
- NASPAG/SAHM Statement: the 21st century cures act and adolescent confidentiality.J Adolesc Health. 2021; 68: 426-428
- Implementing immediate postpartum contraception: a comparative case study at 11 hospitals.Implement Sci Commun. 2021; 2: 42
Article info
Publication history
Published online: February 07, 2023
Accepted:
January 30,
2023
Received in revised form:
January 9,
2023
Received:
October 18,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflicts of Interest: This study was funded in part by a research grant from the Investigator-Initiated Studies Program of Organon. The funder did not have a role in study design, data collection or analysis, manuscript writing, or the decision to submit for publication.
Identification
Copyright
© 2023 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
