Perceived Control in Past Contraceptive Experiences as a Lasting Influence on Contraceptive Behavior: A Focus Group Exploration in Urban African American Women

Introduction: Marked racial disparities persist in the United States in both unintended pregnancy rates and contraceptive use despite widespread availability and efficacy of hormonal contraception. We explored barriers to contraceptive use among African American women using the Integrative Model of Behavioral Prediction as a framework for assessing the impact of past contraceptive experiences, including provider interactions, on behavior. Materials and Methods: We conducted four focus groups consisting of 20 African American women between the ages of 18 and 50 years at an urban, underserved Family Medicine residency clinic. The Integrative Model of Behavioral Prediction was used as a theoretical framework to construct focus group questions. Using a deductive approach, we performed thematic analysis using QSR NVivo 10 to identify major themes. Results: The major themes during focus groups were 1) a lack of perceived control at contraception initiation as an adolescent, 2) negative perceptions of provider encounters based on past experiences, and 3) contraceptive side effects as the most important factor influencing contraceptive choice. Conclusion: Our findings suggest that a lack of perceived control in contraceptive decision-making during past clinical encounters may have a lasting influence on contraceptive behavior. Further research is needed to identify strategies to improve patient-provider communication in this population, particularly related to the first contraceptive encounter.