Exploratory interviews with health center managers, counselors and patients about contraceptive counseling: What is happening and what they would like to see

To obtain perspectives on current counseling practices and areas for improvement, 20 patients, 8 health center managers, 4 clinicians, and 7 medical assistants were interviewed. The interviewees were selected from Planned Parenthood health centers in the greater New Jersey and Washington, D.C. areas in order to reflect the population to whom we would later be administering our intervention. All parties were asked for their views on key pieces of our intended intervention, including using tiered counseling, discussions of pregnancy ambivalence, what waiting room materials would be most useful to preparing patients for counseling, and addressing accuracy of method use in counseling.  Health center staff additionally provided information on current counseling practices including training for counseling, what information was shared with patients, who provides counseling, and how time constraints were dealt with.

The most important activities during counseling, identified by both staff and patients, were to provide education about all contraceptive options, address lifestyle realities, and have counselors convey non-judgmental respect. The concepts of tiered counseling, discussion of pregnancy ambivalence, and building an action plan for accurate use were endorsed by staff and patients alike. A visual tool to present all method options while using principles of tiered counseling was explored at length. All parties felt the tool was useful for organizing the counseling conversation, quickly conveying pertinent information about all method options but quickly focusing counseling on one or two method alternatives.