The Dynamics of Contraceptive Vigilance or Compliance Title X / Region V Family Planning Training Program Carolyne Swain, MS Cathy Conway-Johnson, PhD
Experience Is Inevitable;Learning Is Not. • Contraceptive behavior is a process, not an event. • Contraceptive vigilance reflects a series of repetitive decisions over time. • What really matters is what a woman learns.
Contraceptive Behaviors Are Critical Health Concerns • Societal • Maternal / child health indicators • Abortion rates • Teen pregnancy etiology and rates • Individual • Relationships • Fertility goals • Sexually transmitted infections
Theoretical Models Used to Structure the Clinical Approach • Social Leaning Theory (Bandura, 1977) • People and environment interact continuously. • Theory of Reasoned Action (Ajzen & Fishbein, 1996) • Human beings make rational decisions based on available information. • Health Belief Model (Hochbaum, Rosenstock, Leventhal, and Kegeles, 1958) • Behavior mediated through cognitions.
Models of Individual Behavior • Direct attention to dimensions of decision making and behavior • Sexual behavior is more complex than traditional models allow • Contraceptive behavior is • Dynamic • Dyadic • Contextual
Influence of Contextual Variables • Kristen Luker, 1975 • Both contraception and pregnancy have risks and benefits that each woman evaluates • Vigilance changes over time in differing circumstances • Warren Miller, 1986 • Contraceptive vigilance is an internal balance of competing dimensions • Behavior is conditioned by perceptions, user – method characteristics, partner and personal stability
Contraceptive Behavior = Feedback Loop • Behavior encompasses • Method choice and initiation • Method use • Method changes • Each encounter creates positive or negative feedback • Must extinguish old behavior: no method, no condom • Must habituate new behavior: protected intercourse, intentional sexual behavior • Vigilance requires that decisions yield anticipated results
Links Among Knowledge, Attitude, Beliefs, Skills and Behavior • Perceived valuation of pregnancy • Perceived risk of pregnancy • Assessment of contraceptive method and its risks • Interaction of user and method in context of particular relationship • Moral or ethical values individual, family, community
Links Among Knowledge, Attitude, Beliefs, Skills and Behavior (continued) • Effect of relationship status • Casual / main • Marital / other • Age disparity • Gender roles / power differentials • Effect of socio-cultural environment • Age of debut, marriage, childbearing • Community norms • Gender roles
Contraception Embedded in Relationship ♀ ♂ Pregnancy Method
Counselor’s Role • Facilitate contraceptive strategy • Meet client’s needs • Meet professional responsibility • Enlarge field of clinical gaze to include micro- behaviors needed for success • Understand contraceptive behavior is not a method
Medical History • Determine client’s method eligibility • Conduct appropriate screening tests • Discharge professional public health responsibilities
Social History • Explore pertinent factors affecting reproductive health behaviors • Street drug use • Alcohol • Education / employment • Relationship status, partner views • Family
Mitigating Circumstances (Oakley, 1994) • Attributes that require special counseling • No successful previous contraceptive behavior • No future plans • No social support to avoid unintended pregnancy • Cognitive impairment • Pregnancy valence • Relationship history • All affect successful contraceptive behavior
Counseling Targeted To Selected Method • Correct use • Common side effects • Benefits • Goodness of fit • Reinforced with written materials
Institutional Systems • Do they facilitate or impede a patient’s success? • Clinic operations • Community supports / incentives / disincentives • Follow-up procedure / policy
In Summary • Contraceptive behavior is • Complex • Situated in sexual life • Subject to social mores • Linked to partner • Decision to contracept is continually reviewed and remade • Vigilance requires that contracepting solves a problem or achieves a goal
Practitioner’s Overarching Goal • Provide women with the resources they need when they need them. • Provide women with the support necessary to obtain and use those resources.
Funding Provided By • DHHS / OPA / OFP • Title X Family Planning Program • FP Training Grant # FPTPA050032-02 • Region V / Title X Family Planning Training Program
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