Impact of trust in the health care system on use of LARC
Contraception
Awarded 2012
Trainee Grants
Rachel Stacey, MD
Medical University of South Carolina
$3,750

Background: Women with a recent history of abortion are at high risk for unintended pregnancy and repeat abortion. Several barriers prevent these women from using more highly effective methods of contraception, such as long-acting reversible contraception (LARC), immediately post-abortion. The role of an individual’s trust in the health care system may be an important component in a patient’s health care decision-making. This study measures individual trust scores among women seeking first trimester abortions and investigates whether a women’s trust in her health care system is associated with a willingness to consider LARC use immediately post-abortion. Study Design: A structured survey was administered to 162 patients presenting to an abortion-providing facility in the US for pregnancy termination from 2012-2013. The survey was comprised of both previously validated and newly developed questions to measure trust and other potentially related factors in contraceptive decision-making. Participants completed a self-administered questionnaire and a private assessment of health literacy using the Rapid Estimate of Adult Literacy in Medicine-Revise (REALM-R). Results: Of the 162 participants enrolled, 161 completed the survey and were included in the final analysis. Among women seeking abortion, the overall mean trust score was 59 (SD 8). Women who indicated a willingness to use LARC immediately post-abortion had a mean trust score of 59.13 (SD 7.75). Similarly, participants who reported unwillingness or uncertainty regarding the use of LARC immediately post-abortion had a mean trust score of 59.07 (SD 8.07). Participant trust scores ranged from a low of 38 to a high of 78. Most participants indicated a plan to use contraception post-abortion; 28% desired less effective methods (condoms, barrier, abstinence), 38% indicated moderately effective (pills, patch, vaginal ring, DMPA) and 33% wanted highly effective (LARC, sterilization). 24% of participants indicated a plan to use post-abortion LARC, however, over 37% of participants reported that they would choose LARC if immediately available at the time of their abortion. Conclusion: There was no difference in mean trust scores for women who reported that they would accept LARC immediately post-abortion compared to those who would not. More than one-third of participants reported that they would accept a LARC device immediately post-abortion if available, demonstrating interest in highly effective contraception among women seeking abortion services. Other factors associated with a willingness to use LARC immediate post-abortion include prior pregnancy, parity, prior abortion, income and marital status.

Skip to toolbar