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Assessing motivating factors for IUD self-removal through focus groups and simulation
Melissa L Wong1, Rushina Pancholi2, Leanne Yinusa-Nyahkoon3
1Montefiore Medical Center/Albert Einstein School of Medicine, Bronx, NY, United States.
Objectives:
To investigate motivating factors for IUD self-removal in IUD ever-users and the attitudes of simulated removal in supporting IUD removal decision-making.
Study Design:
We conducted three semi-structured focus group discussions grounded in the Theory of Planned Behavior to identify perceptions around self-removal and promoting IUD self-removal among IUD ever-users. We defined promoters as tools or resources to support IUD self-removal. Participants performed simulated standard IUD removal using a model. The research team used thematic analysis to code focus group transcripts and identify themes centered around promoters and perceptions of IUD self-removal.
Results:
Participants (n = 25) were 18-33 years old and from the greater Boston region. Our primary themes were: 1) information about IUD self-removal is a means to centering patients' needs and 2) participants desire support and resources regarding IUD self-removal. Participants largely viewed IUD self-removal as positive because it was a mechanism to manage side effects, control what is in their body, and mitigate negative healthcare experiences and restrictions within the healthcare system. IUD removal simulation decreased fear and increased perceived control.
Conclusions:
IUD self-removal is a desired, yet underutilized method of IUD discontinuation. Participant consideration of self-removal reflected the desire for control in the setting of systemic healthcare and clinician-based barriers. Participants wanted more self-efficacy in IUD removal experiences, which may be the most important aspect of removal to some respondents. Clinicians can support IUD self-removal by providing instruction on steps to self-removal and allowing patients to practice self-removal with simulation in the office.
Implications:
IUD self-removal is a desired method of IUD discontinuation that may afford reproductive autonomy in the setting of systemic and clinician-based barriers. Participants requested support for IUD self-removal from their clinicians, which could include anticipatory counseling, use of simulation models, or supporting attempted self-removal in the office.
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