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J Adolesc Health. 2013 Mar;52(3):293-300. doi: 10.1016/j.jadohealth.2012.07.004. Epub 2012 Aug 25.

Identifying counseling needs of nulliparous adolescent intrauterine contraceptive users: a qualitative approach.

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Division of Community Health and Human Development, University of California Berkeley-University of California San Francisco, Joint Medical Program, Berkeley, CA, USA.



To describe the intrauterine contraception (IUC) adoption process among nulliparous adolescents and to identify the role of the medical provider in this trajectory.


We conducted semistructured interviews with a clinic-based sample of 20 nulliparous adolescents (aged 15-24 years) with a history of IUC use. Interviews were analyzed using modified grounded theory and cross-case analysis to reveal a process model for IUC adoption, with a focus on the role of the medical provider.


The model includes the following stages: first awareness, initial reaction, information gathering, adoption, and adjustment and reassessment. It is influenced by personal preferences and experiences, friends, family, sexual partner(s), and medical providers. Interactions with medical providers that study participants found helpful in navigating the adoption process included the use of visuals; tailored counseling to address specific contraceptive needs; assurance that IUC discontinuation was an option; information on a wide range of side effects; medical provider self-disclosure regarding use of IUC; and addressing and validating concerns, both before and after IUC insertion.


Nulliparous adolescents in this study described a complex IUC adoption process in which the medical provider plays a substantial supportive role. Findings from this study may be used to counsel and support future nulliparous adolescents regarding IUC use.

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