Contraceptive prescription: physician beliefs, attitudes and socio-demographic characteristics

Abstract

Physicians are important gatekeepers of women's access to effective methods of contraception. An understanding of physician behaviour in this domain is therefore important. This cross-sectional survey examined physician beliefs, attitudes, intentions and behaviour with respect to contraceptive prescription. Physician gender was associated with attitudes to diaphragm prescription, while year of medical graduation was associated with attitude to IUCD prescription. Age and gender in turn were related to differing perceptions of methods pertaining to efficacy, adverse effects, women for whom the methods were suitable and possible impacts on the physician. Regional differences in prescribing of these methods may be due to variations in physician age and gender.

PIP: The importance of physician's socioeconomic characteristics, intentions, attitudes, and beliefs in influencing prescribing of the oral contraceptive (OC), intrauterine device ((IUCD), and the diaphragm is investigated. The random sample included 313 nonspecialist physicians from Calgary, Canda in 1986/87 of whom 210 were respondents. Data analysis involved cross tabulations, analysis of variance, and nested multiple logistic models with the likelihood ratio test. The group demographic characteristics were presented, males mean = 43.6 years and females mean = 35 years. 48.3% had a median of 3 months of postgraduate training in obstetrics and gynecology (OBGYN). Regional variations persist in contraceptive behavior, but this may be due to the distribution of male vs female physicians. 82.3% did IUCD insertions. 78.5% fit diaphragm, (females were more likely to perform diaphragm fitting). 92.5% indicated post interview that they planned to prescribe OCs, 58.6% IUCDs, and 54.8% diaphragms. 97.1% had positive attitudes toward OC prescription, 33% toward IUCD prescription, and 66% toward diaphragm prescription. The following factors were unrelated to attitudes toward prescribing each method of contraception: time of medical graduation, gender, religion, OBGYN training, formal training in contraception, or Certification in Family Medicine. Year of medical graduation was associated with a positive attitude to IUCD prescription; i.e. fewer graduating after 1970 had positive attitudes. Gender was related to positive attitudes toward diaphragm prescription; 86.6% of females vs 59.6% males. Medical graduated prior to 1969 differed in their beliefs significantly from graduated after 1970 in the following areas of IUCD use: attributed of women, attributes of the device, adverse effects, and problems for the physician. Later graduates valued efficacy of the IUCD more highly, felt side effects of the IUCD were greater, had a more negative value of PID as an outcome, and perceived greater difficulties in insertion. Beliefs about diaphragm prescription focused on systemic effects on health, efficacy, requirement for patient education, and risk of urinary tract infection (UTI). Women valued the effectiveness of the diaphragm and the absence of systemic effects, but considered the likelihood of UTI to be higher; patients needed greater involvement in education. A limitation is that context specific differences in attitudes and behavior are not identifiable and respondents are not representative of Calgary family physicians.