Stages of change: A patient-centered study on LARC removal
Awarded 2016
Large Research Grants
Liza Fuentes, MPH
Guttmacher Institute

Removing barriers to LARC use has been lauded as an important strategy for reducing unintended pregnancy, yet there has been little attention to women’s experiences of LARC’s “reversibility,” a perceived advantage of LARC over sterilization and a key feature of the life cycle of LARC use. The scant research examining LARC removal indicates that women may face multilevel barriers to removal and that the perception that removal may be difficult is enough to dissuade some women from considering LARC. This study aims to fill an important gap in the literature on LARC removal as a foundation to inform clinical recommendations that enhance reproductive autonomy. Using mixed methods and a patient-centered approach, this project will describe LARC users’ experiences and perceptions regarding device removal; elucidate facility-, payor-, and provider-related factors that facilitate or hinder a desired LARC removal; and identify LARC removal preferences. The study employs the transtheoretical model stages of behavior change to highlight dynamic decision-making processes and identify salient barriers and facilitators at various stages of the LARC removal process. Survey and qualitative interviews will be conducted in four states with a purposive sample of current and former LARC users (ages 15-44) who are in distinct stages of behavior change with regard to LARC removal. Results will inform the development of a multi-level framework for barriers and facilitators to LARC removal; clinical recommendations based on patients’ preferences regarding removal and method switching; and translational materials disseminated to advocates and policymakers to reduce structural barriers to removal.