Quality and Content of Patient-Provider Communication About Contraception: Differences by Race/Ethnicity and Socioeconomic Status

Abstract

Introduction: Research in family planning has shown that contraceptive counseling has an influence on women's family planning outcomes, but also that women are often dissatisfied with the counseling they receive. Little is known about how contraceptive counseling is conducted in the United States. We describe both the content and interpersonal quality of provider communication during family planning visits, as well as assess whether disparities in counseling exist by patient race/ethnicity and socioeconomic status.

Methods: We obtained audio recordings of contraceptive counseling clinic visits for 339 women ages 15-45, which were coded for content and quality of communication, and collected surveys regarding demographics, contraceptive preferences, and experience with care. We performed descriptive analyses of the content and quality of provider-patient communication, and conducted multivariate logistic regression to assess for racial/ethnic and socioeconomic differences in care.

Results: Providers frequently did not communicate with patients about issues relevant to their family planning needs, including their pregnancy intention (assessed in 51% of visits) and their preferences for birth control (64% of visits). Providers also inconsistently offered patients a chance to ask questions (53% of visits). For most measures, there were no differences by patient race/ethnicity and highest level of parental education achieved. Patients whose parents had a high school education or less were significantly less likely to have long-acting reversible contraceptive methods mentioned during the visit (adjusted odds ratio, 0.42; p = .03).

Conclusions: Several deficiencies in contraceptive counseling were found, suggesting areas for further emphasis in training. Differences by race/ethnicity and socioeconomic states were not marked.