{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T04:55:28Z","timestamp":1764305728728},"reference-count":35,"publisher":"Walter de Gruyter GmbH","issue":"11","license":[{"start":{"date-parts":[[2019,11,1]],"date-time":"2019-11-01T00:00:00Z","timestamp":1572566400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_jaoa.2019.122_s_001\">\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>Providing long-acting reversible contraception (LARC; eg, subdermal implants and intrauterine devices [IUDs]) can help mitigate rates of unintended pregnancy because they are the most effective reversible contraceptive methods. However, many varied barriers to LARC placement are reported. Medical education and training can be tailored if there is a better understanding of how barriers predict LARC referral and to predicting LARC placement.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jaoa.2019.122_s_002\">\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To understand how a variety of key barriers to LARC placement are related to one another; to identify which of the barriers, when considered simultaneously, predict LARC referral and LARC placement; and to assess the barriers to LARC placement that persist, even when a major barrier, training, is removed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jaoa.2019.122_s_003\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We recruited providers (obstetricians and gynecologists, family physicians, pediatricians, internal medicine physicians, certified nurse practitioners, and certified nurse midwives) across the state of Ohio. Participants were compensated with a $35 Amazon gift card for completing an online survey comprising 38 Likert-type items, an 11-item knowledge test, LARC placement and referral questions, and demographic questions. We conducted data analyses that included correlations, odds ratios, and independent samples <jats:italic>t<\/jats:italic> tests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jaoa.2019.122_s_004\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 224 providers participated in the study. Long-acting reversible contraception knowledge, training, and provider concerns were correlated with one another. Training was found to positively predict placement and negatively predict referral when other barriers, such as knowledge and provider concerns, were considered simultaneously. Of providers who were trained to place implants, 18.6% (n=16) said they referred implant placement, and 17.4% (n=15) said they did not place implants. Of providers who were trained to place IUDs, 26.3% (n=26) said they referred IUD placement, and 27.3% (n=27) said they did not place IUDs. Those who referred placement and those who did not place LARCs reported greater barriers (in type and magnitude) to LARC placement than those who did place LARCs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jaoa.2019.122_s_005\">\n                  <jats:title>Conclusion(s)<\/jats:title>\n                  <jats:p>Long-acting reversible contraception knowledge, training, and provider concerns about barriers to LARC placement were interdependent. Even when providers were trained to place LARCs, a significant portion referred or did not place them. Efforts to increase LARC placement need to address multifaceted barriers.<\/jats:p>\n               <\/jats:sec>","DOI":"10.7556\/jaoa.2019.122","type":"journal-article","created":{"date-parts":[[2019,10,28]],"date-time":"2019-10-28T14:30:39Z","timestamp":1572273039000},"page":"725-734","source":"Crossref","is-referenced-by-count":2,"title":["How Long-Acting Reversible Contraception Knowledge, Training, and Provider Concerns Predict Referrals and Placement"],"prefix":"10.1515","volume":"119","author":[{"given":"Charee M.","family":"Thompson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Broecker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maggie","family":"Dade","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2019,11,1]]},"reference":[{"issue":"9","key":"2022022617185391449_j_jaoa.2019.122_ref_001","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1056\/NEJMsa1506575","article-title":"Declines in unintended pregnancy in the United States, 2008-2011","volume":"374","author":"Finer","year":"2016","journal-title":"N Engl J Med."},{"key":"2022022617185391449_j_jaoa.2019.122_ref_002","year":"2016"},{"issue":"5","key":"2022022617185391449_j_jaoa.2019.122_ref_003","first-page":"e251","volume":"130","author":"Committee on Practice Bulletins-Gynecology, Long-Acting Reversible Contraception Work Group. Practice bulletin no. 186: long-acting reversible contraception: implants and intrauterine devices.","year":"2017","journal-title":"Obstet Gynecol."},{"issue":"2","key":"2022022617185391449_j_jaoa.2019.122_ref_004","doi-asserted-by":"publisher","first-page":"e32","DOI":"10.1097\/AOG.0000000000001587","volume":"128","author":"American College of Obstetricians and Gynecologists\u2019 Committee on Obstetric Practice. Committee opinion no. 670: immediate postpartum long-acting reversible contraception.","year":"2016","journal-title":"Obstet Gynecol."},{"issue":"5","key":"2022022617185391449_j_jaoa.2019.122_ref_005","doi-asserted-by":"publisher","first-page":"e130","DOI":"10.1097\/AOG.0000000000002632","volume":"131","author":"American College of Obstetricians and Gynecologists. Committee opinion no. 735: adolescents and long-acting reversible contraception: implants and intrauterine devices.","year":"2018","journal-title":"Obstet Gynecol."},{"issue":"3","key":"2022022617185391449_j_jaoa.2019.122_ref_006","doi-asserted-by":"crossref","first-page":"e69","DOI":"10.1097\/AOG.0000000000001644","volume":"128","author":"American College of Obstetricians and Gynecologists. Committee opinion no 672: clinical challenges of long-acting reversible contraceptive methods.","year":"2016","journal-title":"Obstet Gynecol."},{"issue":"4","key":"2022022617185391449_j_jaoa.2019.122_ref_007","first-page":"e1244","article-title":"-","volume":"134","author":"American Academy of Pediatrics Committee on Adolescence. Contraception for adolescents","year":"2014"},{"issue":"8","key":"2022022617185391449_j_jaoa.2019.122_ref_008","doi-asserted-by":"crossref","first-page":"969","DOI":"10.2165\/11591290-000000000-00000","article-title":"Efficacy and safety of long-acting reversible contraception","volume":"71","author":"Stoddard","year":"2011","journal-title":"Drugs"},{"issue":"1","key":"2022022617185391449_j_jaoa.2019.122_ref_009","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.contraception.2017.10.003","article-title":"Contraceptive method use in the United States: trends and characteristics between 2008, 2012 and 2014","volume":"97","author":"Kavanaugh","year":"2018","journal-title":"Contraception."},{"issue":"6","key":"2022022617185391449_j_jaoa.2019.122_ref_010","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1016\/j.jadohealth.2015.02.016","article-title":"Providing long-acting reversible contraception services in Seattle school-based health centers: key themes for facilitating implementation","volume":"56","author":"Gilmore","year":"2015","journal-title":"J Adolesc Health"},{"issue":"5","key":"2022022617185391449_j_jaoa.2019.122_ref_011","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1016\/j.jpag.2016.01.125","article-title":"Interdependent barriers to providing adolescents with long-acting reversible contraception: qualitative insights from providers","volume":"29","author":"Murphy","year":"2016","journal-title":"J Pediatr Adolesc Gynecol"},{"issue":"1","key":"2022022617185391449_j_jaoa.2019.122_ref_012","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.jpag.2016.07.002","article-title":"Barriers and facilitators to adolescents\u2019 use of long-acting reversible contraceptives","volume":"30","author":"Pritt","year":"2017","journal-title":"J Pediatr Adolesc Gynecol"},{"issue":"2","key":"2022022617185391449_j_jaoa.2019.122_ref_013","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.nwh.2017.02.007","article-title":"Barriers to health care providers\u2019 provision of long-acting reversible contraception to adolescent and nulliparous young women","volume":"21","author":"Hopkins","year":"2017","journal-title":"Nurs Womens Health"},{"issue":"4","key":"2022022617185391449_j_jaoa.2019.122_ref_014","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1097\/jxx.0000000000000019","article-title":"Barriers to implementation of long-acting reversible contraception: a systematic review","volume":"30","author":"Phillips","year":"2018","journal-title":"J Am Assoc Nurse Pract"},{"issue":"3","key":"2022022617185391449_j_jaoa.2019.122_ref_015","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1097\/AOG.0000000000000137","article-title":"Factors influencing the provision of long-acting reversible contraception in California","volume":"123","author":"Biggs","year":"2014","journal-title":"Obstet Gynecol"},{"issue":"6","key":"2022022617185391449_j_jaoa.2019.122_ref_016","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/j.contraception.2014.02.008","article-title":"Obstetrician\u2013gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations","volume":"89","author":"Luchowski","year":"2014","journal-title":"Contraception"},{"issue":"1","key":"2022022617185391449_j_jaoa.2019.122_ref_017","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.jpag.2016.09.001","article-title":"Pediatricians\u2019 attitudes and beliefs about long-acting reversible contraceptives influence counseling","volume":"30","author":"Berlan","year":"2017","journal-title":"J Pediatr Adolesc Gynecol"},{"issue":"5","key":"2022022617185391449_j_jaoa.2019.122_ref_018","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1016\/j.contraception.2013.06.005","article-title":"Global survey of healthcare practitioners\u2019 beliefs and practices around intrauterine contraceptive method use in nulliparous women","volume":"88","author":"Black","year":"2013","journal-title":"Contraception"},{"key":"2022022617185391449_j_jaoa.2019.122_ref_019","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1016\/j.ejogrb.2014.10.020","article-title":"Understanding the barriers and myths limiting the use of intrauterine contraception in nulliparous women: results of a survey of European\/Canadian healthcare providers","volume":"183","author":"Buhling","year":"2014","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"4","key":"2022022617185391449_j_jaoa.2019.122_ref_020","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1542\/hpeds.2017-0167","article-title":"Contraception for adolescents and young adults in the inpatient setting: the providers\u2019 perspective","volume":"8","author":"Goldstein","year":"2018","journal-title":"Hosp Pediatr"},{"issue":"6","key":"2022022617185391449_j_jaoa.2019.122_ref_021","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1097\/AOG.0b013e318173fd83","article-title":"Challenges in translating evidence to practice: the provision of intrauterine contraception","volume":"111","author":"Harper","year":"2008","journal-title":"Obstet Gynecol"},{"issue":"3","key":"2022022617185391449_j_jaoa.2019.122_ref_022","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1363\/psrh.12071","article-title":"Barriers and pathways to providing long-acting reversible contraceptives in Massachusetts community health centers: a qualitative exploration","volume":"50","author":"Janiak","year":"2018","journal-title":"Int Perspect Sex Reprod Health"},{"issue":"3","key":"2022022617185391449_j_jaoa.2019.122_ref_023","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.jadohealth.2016.03.039","article-title":"Access barriers to long-acting reversible contraceptives for adolescents","volume":"59","author":"Kumar","year":"2016","journal-title":"J Adolesc Health"},{"issue":"2","key":"2022022617185391449_j_jaoa.2019.122_ref_024","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1370\/afm.1450","article-title":"New York City physicians\u2019 views of providing long-acting reversible contraception to adolescents","volume":"11","author":"Rubin","year":"2013","journal-title":"Ann Fam Med"},{"key":"2022022617185391449_j_jaoa.2019.122_ref_025","volume-title":"Providers\u2019 Knowledge, Perceptions and Views of Prescribing Long-Acting Reversible Contraception to Adolescents in a Southwest Community Health Center [dissertation]","author":"Schafer","year":"2017"},{"issue":"4","key":"2022022617185391449_j_jaoa.2019.122_ref_026","doi-asserted-by":"publisher","first-page":"S14","DOI":"10.1016\/j.jadohealth.2013.02.003","article-title":"Myths and misconceptions about long-acting reversible contraception (LARC)","volume":"52","author":"Russo","year":"2013","journal-title":"J Adolesc Health"},{"issue":"2","key":"2022022617185391449_j_jaoa.2019.122_ref_027","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.contraception.2017.05.007","article-title":"\u201cI wish they could hold on a little longer\u201d: physicians\u2019 experiences with requests for early IUD removal","volume":"96","author":"Amico","year":"2017","journal-title":"Contraception"},{"issue":"2","key":"2022022617185391449_j_jaoa.2019.122_ref_028","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.jpag.2012.10.006","article-title":"Long-acting reversible contraception for adolescents and young adults: patient and provider perspectives","volume":"26","author":"Kavanaugh","year":"2013","journal-title":"J Pediatr Adolesc Gynecol"},{"issue":"5","key":"2022022617185391449_j_jaoa.2019.122_ref_029","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.jpag.2018.03.007","article-title":"Influences on intentions to place long-acting reversible contraceptives: a pilot study comparing according to provider specialty in Ohio","volume":"31","author":"Thompson","year":"2018","journal-title":"J Pediatr Adolesc Gynecol"},{"issue":"4","key":"2022022617185391449_j_jaoa.2019.122_ref_030","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.3758\/BRM.41.4.1149","article-title":"Statistical power analyses using G* Power 3.1: tests for correlation and regression analyses","volume":"41","author":"Faul","year":"2009","journal-title":"Behav Res Methods"},{"issue":"6","key":"2022022617185391449_j_jaoa.2019.122_ref_031","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1016\/j.jadohealth.2016.07.018","article-title":"Long-acting reversible contraception counseling and use for older adolescents and nulliparous women","volume":"59","author":"Gibbs","year":"2016","journal-title":"J Adolesc Health"},{"issue":"6","key":"2022022617185391449_j_jaoa.2019.122_ref_032","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1016\/j.ajog.2018.03.016","article-title":"Training contraceptive providers to offer intrauterine devices and implants in contraceptive care: a cluster randomized trial","volume":"218","author":"Thompson","year":"2018","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"2022022617185391449_j_jaoa.2019.122_ref_033","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.whi.2018.04.010","article-title":"Establishing and conducting a regional, hands-on long-acting reversible contraception training center in primary care","volume":"28","author":"Rubin","year":"2018 Sep 1","journal-title":"Women's Health Issues"},{"issue":"2","key":"2022022617185391449_j_jaoa.2019.122_ref_034","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.contraception.2013.10.014","article-title":"Immediate postabortion access to IUDs, implants and DMPA reduces repeat pregnancy within 1 year in a New York City practice","volume":"89","author":"Langston","year":"2014","journal-title":"Contracept"},{"issue":"2","key":"2022022617185391449_j_jaoa.2019.122_ref_035","doi-asserted-by":"publisher","first-page":"115.e1","DOI":"10.1016\/j.ajog.2010.04.017","article-title":"The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception","volume":"203","author":"Secura","year":"2010","journal-title":"Am J Obstet Gynecol"}],"container-title":["Journal of Osteopathic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.7556\/jaoa.2019.122\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.7556\/jaoa.2019.122\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,26]],"date-time":"2022-02-26T17:19:45Z","timestamp":1645895985000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.7556\/jaoa.2019.122\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,1]]},"references-count":35,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2019,11,1]]},"published-print":{"date-parts":[[2019,11,1]]}},"alternative-id":["10.7556\/jaoa.2019.122"],"URL":"https:\/\/doi.org\/10.7556\/jaoa.2019.122","relation":{},"ISSN":["2702-3648"],"issn-type":[{"value":"2702-3648","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,1]]}}}