Intrauterine contraception (IUC): Impact of provider training on candidate selection and method provision

Intrauterine contraception (IUC) is a highly effective long-acting contraceptive method but utilization in the United States remains low. Reasons for low IUC utilization rates include lack of training on device insertion and prevalence of overly strict criteria defining appropriate candidates such as avoiding insertions to nulliparous or adolescent clients. From 2006/2007 to 2009/2010, the California Office of Family Planning offered nine IUC skills training sessions, including hands-on practica, to clinician providers enrolled in the state's Medicaid 1115 Family Planning Waiver program, Family PACT. A total of 249 Family PACT clinicians attended. The majority were physician-extenders (69%), practicing in public clinics (65%) as general primary care providers (67%), and were licensed an average of 17 years. We analyzed change on three dimensions: knowledge of appropriate candidate selection, overall IUC insertion rates before and after the training, and increase in IUC insertion rates to nulliparous and adolescent clients. Summary scores on the nine-item IUC Candidate knowledge scale changed from an average of 23.2 on the pretest to 26.3 on the posttest (p<0.05); Cronbach's alpha was 0.787 pretest and 0.753 on the posttest. Participants showed significant change in candidate knowledge for eight of the patient categories in our scale; mean change on the individual 5-point items ranged from 0.61 to 1.22; all p values <0.05. Provision of IUCs increased at sites where staff participated in training by an average of 13.4 insertions in the 6-month period following attendance (p<0.05). The provision of IUCs can be increased through skills-based IUC insertion training.