Associations Between Contraceptive Counseling Quality and Contraceptive Use in a National Survey of Women Veterans

Background: Contraceptive counseling quality is associated with trust in providers, method satisfaction, and method continuation. Little is known, however, about associations between counseling quality and method choice, particularly for methods requiring a high level of involvement of providers to initiate and stop the method. Objective(s): Investigate associations between experiences of high- or low-quality counseling and contraceptive method type. Research Design: We analyzed data from a national survey of women veterans ages 18-44 receiving care at the Veterans Health Administration (VA). Among participants who received contraceptive services at VA in the past year (n = 358), counseling quality was assessed with six Likert-scale items capturing key elements of patient-centered care. We explored two independent counseling quality variables: (1) high-quality (strongly agree on all items) versus all other responses and (2) low-quality (neutral/disagree/strongly disagree on ≥4 items) versus all other responses. Contraceptive methods were categorized based on the level of provider involvement required for initiation and discontinuation: long-acting reversible contraceptive (LARC) procedures, prescription methods, and those that require no provider involvement. We examined associations between quality and method type used using logistic regression models, controlling for potential confounding covariates. Results: Veterans reporting high-quality counseling were more likely (aOR: 1.95; 95% CI: 1.09, 3.48), and those reporting low-quality counseling were less likely (aOR: 0.12; 95% CI: 0.02, 0.90), to have undergone LARC placement. Veterans reporting low-quality counseling were more likely to have used a method that required no provider involvement (aOR: 2.71; 95% CI: 1.26, 5.83). Conclusions: High-quality contraceptive counseling is associated with use of LARC methods, while low-quality counseling is associated with use of contraceptives that require no provider involvement.