Barriers and Facilitators to Diaphragm Use among Nurse Practitioners in Women's Health

New preventive strategies are needed against unintended pregnancy and sexually transmitted infections (STIs), including HIV. Some evidence that the diaphragm protects against cervical STIs is leading to a re-appraisal of this method, now rarely used for contraception. Ongoing Phase-3 trials are investigating its efficacy for STI/HIV prevention. However, little is known about provider perspectives and beliefs about this prescription method. Filling this knowledge gap is critical to the diaphragm's successful re-introduction. We conducted formative research to develop a survey questionnaire to examine barriers and facilitators to diaphragm use, both from the perspective of providers and their perception of patients' concerns. We administered the questionnaire nationally to 450 Nurse Practitioners in Women's Health (NPWH). Descriptive and multivariate analyses of the data were conducted. A representative sample of the NPWH membership was obtained (response rate=47%). Although 88% of respondents had ever fitted a diaphragm, 40% had not done so in the past year. The three biggest barriers for providers are its lack of promotion by women's health providers, doubts about its efficacy, and limited familiarity with the method. Asked about barriers from their patients' perspective, providers indicated that their patients lacked peers who used the diaphragm, felt it may disrupt sexual spontaneity, and felt it is hard to position correctly. Respondents indicated that primary facilitators to promote diaphragm use are that it is 1) safe/free of hormonal side-effects, 2) female-controlled, 3) reusable and inexpensive. The information collected in this study will assist efforts to plan provider-based interventions to promote successful method re-introduction.