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  • Title: The attitudes of clinic staff as factors in women's selection of Norplant implants for their contraception.
    Author: Frank ML, Bateman L, Poindexter AN.
    Journal: Women Health; 1994; 21(4):75-88. PubMed ID: 7941612.
    Abstract:
    Medical and counseling staff at 13 family planning clinics in Texas, U.S.A., were surveyed regarding their opinions and level of information about the contraceptive Norplant. These responses were used to assess the relationships between clinicians' information and attitudes about the contraceptive and the use of that method by their patients. No differences were associated with respondents' clinical responsibilities or with their type of professional training. However, significant variations in the numbers of patients receiving Norplant from individual providers, and in the proportion receiving the method from certain clinics, were associated with responses to some attitudinal questions. These findings suggest that the opinions about Norplant held by personnel staffing family planning clinics influence the method selection of their patients. A survey of medical and counseling staff at 13 family planning clinics in Texas suggested that contraceptive method selection, particularly with regard to Norplant, is closely linked to health care professionals; opinions about the various methods. Since all 13 clinics were operated by Planned Parenthood, the protocol for counseling was uniform. 65.2% of the 90 clinicians who completed questionnaires indicated they always or usually discussed Norplant with family planning patients. 7 facilities dispensed Norplant to less than 6% of their patients; the remaining 6 had distribution rates of at least 10.5%. Providers who had received in-service training on Norplant were significantly more likely than their informally educated counterparts to prescribe Norplant as were those who were aware the method had no permanent effect on future fertility. 29% of clinical staff at high distribution sites claimed they would recommend implants over sterilization compared to 8.3% of those at low distribution sites. An analysis of responses to opinion questions about Norplant indicated that there was a significant association (p 0.01) between the number of clients who received Norplant and staff members' agreement with the following items: a woman can use Norplant regardless of how many children she has, the high cost of the implants is worthwhile, the method is good for child spacing, the implants are a suitable method for women with human immunodeficiency virus (HIV) infection, and women under 18 years of age are appropriate candidates for its use. Overall, 35% of respondents believed Norplant posed a greater potential danger than the pill, 37% felt the implants were more dangerous than tubal ligation surgery, and 16% rated Norplant as more risky than the IUD; there was no association between perceptions of relative danger and patterns of distribution, however. Concerns about Norplant focused on the lack of screening criteria, its failure to protect against HIV, and a need for more research. The service provided to family planning clients would be improved with enhanced in-service training. The identification of women for whom Norplant is most suitable, and practitioner awareness of the extent to which personal opinions influence counseling approach.
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