Purpose: To describe Decisional Conflict (DC) surrounding contraceptive decisions by adult women and their male intimate partners and apply the Ottawa Decision Support Framework (ODSF) to assess the determinants of those decisions.
Method: We conducted individual semi-structured interviews exploring the contraceptive and reproductive experiences, preferences and decisions of adult women at risk of unintended pregnancy and their male intimate partners in outpatient primary care settings. We analyzed the interviews for DC and for ODSF themes relating to the four determinants of contraceptive decisions: 1. individual perceptions, 2. perceptions of others, 3. resources for decision-making, and 4. individual or practitioner characteristics. We then analyzed interviews of individuals who expressed DC related to their current contraceptive choice for sources of DC important to that decision.
Result: Forty women and 6 intimate male partners participated in interviews. When considering all contraceptive decisions (current and past) in the context of ODSF determinants, individual characteristics such as age or race in relation to their contraceptive decision were rarely discussed. The most salient ODSF themes related to individual perceptions and resources for contraceptive decision-making. Themes related to the perceived risks or side effects and to the ease of use of contraceptives were prominent within these two ODSF categories. Themes related to relative efficacy were less prominent in all categories. Regarding the current contraceptive choice, less than a third of participants expressed DC, and none reported directly that the decision was difficult for them or that they were unsure how to decide. Participants who described sources of DC related to their contraceptive decision most frequently described lack of knowledge, unrealistic expectations, and lack of self-confidence. But some also reported other sources of DC: unclear values, lack of support, social pressure, and lack of resources.
Conclusion: Prior studies of adult women focused on the relationship between individual characteristics and contraceptive use. In this qualitative analysis, women and their intimate partners related contraceptive decisions to their individual perceptions and their resources for decision-making and not their own individual characteristics. Although the majority of participants did not express DC with their current contraceptive decision, those who did identified sources of DC that can be addressed with patient-directed strategies to provide education and decision support in order to optimize contraceptive care and prevent unintended pregnancies.
See more of: The 32nd Annual Meeting of the Society for Medical Decision Making