Generating a framework for positive and negative contraceptive side effect tolerance
Awarded 2023
Side effects matter: Centering people’s experiences with contraceptive side effects
Kathryn Fay, MD, MSCI
Mass General Brigham

Greater understanding of side effects is an important mechanism for achieving good client experience and alignment of contraceptive function for reproductive goals. While contraceptive side effects are important determining factors in contraceptive satisfaction and continuation, the notion of side effects as unidimensional or binary (present/absent) is too crude to explain current data and user reality. Given that existing data show that many users who experience side effects continue their method anyway, a critical gap in the literature remains in understanding positive tolerance, meaning acceptability of such side effects, and negative tolerance, meaning unacceptability of side effects with contraceptive continuation due to other factors. This project aims to generate a framework for conceptualizing positive and negative contraceptive side effect tolerance, first through secondary analyses of qualitative and quantitative datasets. The preliminary thesis from these analyses will be subject to rigorous review and modification by external counsel, led by a community coalition for equity in research. By centering community and contraceptive users’ priorities, engagement, and perspective, this proposal will complete its theory scaffolding with community studios and one-on-one semi-structured interviews with iterative coalition feedback to produce a framework understandable and usable by clinicians and clients alike. Such insight into positive and negative contraceptive tolerance is critical to improved understanding of the trade-offs required for contraceptive decision-making among the contemporary field of imperfect method choices; further, such data will enhance contraceptive counseling, anticipatory guidance, and clarity of clinical support in facilitating clients’ contraceptive journeys.