Primary objectives:    Are there differences in attitudes and beliefs about IUDs based on age? We hypothesized that older women may be more familiar with the negative outcomes of earlier models of the IUD and therefore may hold more negative attitudes toward IUDs.https://jdc.jefferson.edu/cwicposters/1016/thumbnail.jp

Edwards, Sara

Mercier MD MPH, Rebecca J.

Perriera, MD, MPH, Lisa

English

Primary objectives:    Are there differences in attitudes and beliefs about IUDs based on age? We hypothesized that older women may be more familiar with the negative outcomes of earlier models of the IUD and therefore may hold more negative attitudes toward IUDs.http://jdc.jefferson.edu/cwicposters/1016/thumbnail.jp

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Does Age Influence Knowledge and Attitudes about Intrauterine Devices?

Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsCWIC Posters Jefferson College of Population Health11-30-2016Does Age Influence Knowledge and Attitudesabout Intrauterine Devices?Sara EdwardsThomas Jefferson University, sara.edwards@jefferson.eduLisa Perriera, MD, MPHThomas Jefferson University, lisa.perriera@jefferson.eduRebecca J. Mercier MD MPHThomas Jefferson University, Rebecca.Mercier@jefferson.eduFollow this and additional works at: http://jdc.jefferson.edu/cwicpostersPart of the Obstetrics and Gynecology Commons, and the Public Health CommonsLet us know how access to this document benefits youThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inCWIC Posters by an authorized administrator of the Jefferson Digital Commons. For more information, please contact:JeffersonDigitalCommons@jefferson.edu.Recommended CitationEdwards, Sara; Perriera, MD, MPH, Lisa; and Mercier MD MPH, Rebecca J., "Does Age Influence Knowledge and Attitudes aboutIntrauterine Devices?" (2016). CWIC Posters. 16.http://jdc.jefferson.edu/cwicposters/16Background •  Intrauterine devices (IUDs) are considered “top tier” birth control, including for adolescent and nulliparous women1. •  Usage in the U.S. has increased2 but lags far behind that of other similar countries3. •  Barriers to IUD usage include patient attitudes and lack of education, both of which fuel persistent misinformation and lack of awareness4-7. •  Disparities in contraceptive knowledge by age and race8 and in contraceptive use by race and ethnicity9 have been previously documented. •  There have been no published studies to date looking at the attitudes patients have about IUDs depending on age. Materials and Methods •  We investigated women’s attitudes through a paper survey completed privately and anonymously. •  Recruitment occurred by approaching all women in the Thomas Jefferson OB-GYN outpatient office from June 13 – July 18, 2016. •  Exclusion criteria: o  No English o  <14 years old o  Previously completed o  Declined •  Survey Questions: o  Sexual, contraceptive, and obstetric history o  Socioeconomic questions o  Familiarity with and feelings about IUD o  Statements to agree/disagree with on a 5 point Likert scale, gauging opinions and accuracy of knowledge about IUD (see Figure 1) •  Statistics: we performed an exploratory bi-variable analysis using t tests and chi square testing to determine which of the aspects of IUD knowledge or attitude differed by participant age.  Results and Discussion Figure 2 (below): Demographics of Respondents Results and Discussion Figure 4 (below): Differences between age groups did not retain statistical significance when accounting for confounding factors, such as education level, gravidity, and parity, with the one exception that women aged 21-34 were significantly more likely than their younger counterparts to agree with the statement “Hormonal birth control is safe and effective.”  Conclusions and Next Steps •  We found no significant differences in what women think or know about IUDs based on age. •  Study limitations include voluntary nature of the survey and use of the Jefferson OB-GYN waiting area as representative of the population at large (the question of external validity). •  If attitudes about IUDs differ, perhaps specific contraception counseling interventions can be created to target these beliefs. •  Areas for further research within survey data include investigations into several possibly significant differences between black and white respondents, as well as survey results related to provider trust, sources of birth control information, and health literacy. Does Age Influence Knowledge and Attitudes about Intrauterine Devices? Sara Edwards, Lisa Perriera, MD, MPH, and Rebecca Mercier, MD, MPH Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA References Objective •  Primary objective: Are there differences in attitudes and beliefs about IUDs based on age? •  We hypothesized that older women may be more familiar with the negative outcomes of earlier models of the IUD10 and therefore may hold more negative attitudes toward IUDs.  Figure 1 (below):  Example Likert scale statements •  Response Rate: 38% (521 surveys/1366 individual women approached) •  Overall IUD usage in sample: o  25% of sample had used an IUD (110/445), and 66% of those had a positive experience (73/110) o  43% felt IUD was reliable (181/421) o  Mean self-reported IUD knowledge: 5.5 (on 1-10 scale) Outcome 14-20  (n=26) 21-34  (n=296) 34-50  (n=125) >50 (n=61) p-value Self-rated knowledge  1-10 Mean (SD) 3.4 (+/- 2.59) 5.6 (+/- 2.98) 5.3 (+/- 3.05) 6.0 (+/- 3.06) .024 Ever used IUD Yes – n (%) Y – 0 (0%) Y – 74 (29%) Y – 21 (18%) Y – 12 (24%) .009 IUD reliability (+) – Positive n (%) (+) – 3 (20%) (+) – 108 (44%) (+) – 45 (41%)  (+) – 20 (44%)  .025 “IUD insertion requires surgery.” D – Disagree n (%) D – 8 (53%) D – 174 (70%) D – 70 (67%) D – 35 (80%) .046 “Hormonal birth control is safe and effective.” A – Agree n (%) A – 2 (13%) A - 123 (52%) A – 52 (47%) A – 16 (37%) .012 Age n (%) 14-20 26 (5%) 21-34 296 (58%) 35-50 125 (25%) >50 61 (12%) Race n (%) White 231 (46%) Black 212 (42%) Asian 35 (7%) Other 26 (5%) Education Level n (%) Grade school/Some H.S. 17 (4%) H.S. Diploma/GED 99 (19%) Any College 279 (54%) Any Graduate  School 120 (24%) Insurance n (%) Private 298 (59%) Medicaid 102 (20%) None 3 (1%) Other/Don’t know 99 (20%) Prior Pregnancy n (%) Yes 382 (76%)  No 120 (24%) Children? n (%) Yes 219 (43%) No 285 (57%) Figure 3 (below): Before accounting for confounding factors, five survey outcomes, including two Likert scale statements,  appeared to differ among age groups with statistical significance. Outcome 14-20 21-34 34-50  >50 Self-rated knowledge  1-10 Mean; (CI) 3.4 (reference) 5.6 (+2.2);  (-.36 - 3.13) 5.3 (+1.9); (-1.13 - 2.63) 6.0 (+2.6); (-.92-3.21) IUD reliability OR; (CI) (reference)  .257; (.05 – 1.29) .311; CI (.06 – 1.65) .328; (.06 – 1.89) “IUD insertion requires surgery.” OR; (CI) (reference)  .494; (.15 – 1.63) .923; (.26 – 3.31) .474; (.10 – 2.15) “Hormonal birth control is safe and effective.” OR; (CI) (reference)  3.646; (1.27 – 10.46) 2.511; (.82 – 7.68) 1.005; (.82 – 7.68) 1.  Committee on Practice Bulletins - Gynecology. "Practice Bulletin Number 121: Long-Acting Reversible Contraception: Implants and Intrauterine Devices." The American College of Obstetrics and Gynecology (2011): n. pag. Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Web. 21 July 2016. 2.  Kavanaugh, Megan L., Jenna Jerman, and Lawrence B. Finer. "Changes in Use of Long-Acting Reversible Contraceptive Methods Among U.S. Women, 2009–2012." Obstetrics & Gynecology 126.5 (2015): 917-27. Web. 3.  Sonfield, Adam. "Popularity Disparity: Attitudes About the IUD in Europe and the United States." Guttmacher Institute. Guttmacher Policy Review, 12 Nov. 2007. Web. 18 July 2016. 4.  Callegari, Lisa S., Sara M. Parisi, and Eleanor Bimla Schwarz. "Perceptions of Intrauterine Contraception among Women Seeking Primary Care." Contraception 88.2 (2013): 269-74. Web. 5.  Rubin, Susan E., and Ilana Winrob. "Urban Female Family Medicine Patients' Perceptions About Intrauterine Contraception." Journal of Women's Health 19.4 (2010): 735-40. Web. 6.  Okpo, E., L. Allerton, and S. Brechin. "‘But You Can't Reverse a Hysterectomy!’ Perceptions of Long Acting Reversible Contraception (LARC) among Young Women Aged 16–24 Years: A Qualitative Study." Public Health 128.10 (2014): 934-39. Web. 7.  Teal, Stephanie B., and S. Elizabeth Romer. "Awareness of Long-Acting Reversible Contraception Among Teens and Young Adults." Journal of Adolescent Health 52.4 (2013): n. pag. Web. 8.  Craig, Amaranta D., Christine Dehlendorf, Sonya Borrero, Cynthia C. Harper, and Corinne H. Rocca. "Exploring Young Adults' Contraceptive Knowledge and Attitudes: Disparities by Race/Ethnicity and Age." Women's Health Issues 24.3 (2014): n. pag. Web. 9.  Dehlendorf, C., S.y. Park, C. Emeremni, D. Comer, and S. Borrero. "Racial/ethnic Disparities in Contraceptive Use: Variation by Age and Women's Reproductive Experiences." Contraception 88.3 (2013): 466-67. Web. 10.  Kolata, Gina. “The Sad Legacy of the Dalkon Shield.” The New York Times 6 Dec. 1987: n. pag. Web. •  We then performed regression analysis to assess for confounding by other demographic factors using analysis of variance, logistic regression, or ordinal logistic regression as appropriate for continuous, 2 level, and 3 level outcomes, respectively. The IUD can be felt during sex. IUDs cause weight gain. The IUD can only be used by older women. The IUD may move around during activity. IUD insertion requires surgery. The IUD is banned in the U.S. The IUD is only for women who have children. I understand how the IUD prevents pregnancy. I know how the IUD is inserted. I know enough to decide about getting an IUD. The IUD will affect my ability to get pregnant. I am alarmed or afraid at the idea of the IUD. The IUD is an effective way to prevent pregnancy. IUDs can be removed early. Hormonal birth control is safe and effective. n (%) 

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Does Age Influence Knowledge and Attitudes about Intrauterine Devices?

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