Patient and Provider Perspectives on in a Low-income, Racially Diverse Clinic Population

Gregory M. Gressel, MD

Yale School of Medicine Department of Obstetrics, Gynecology and Reproductive Sciences

This study was a unique mixed-methods assessment of a low-income, racially diverse patient population and their opinions about Bedsider. The study included separate focus groups of patients and clinicians, allowing for comparison of patient and staff perceptions of Bedsider content and its usefulness in contraceptive counseling and decision-making. Patients also completed surveys assessing contraceptive knowledge and intentions before and after taking time to explore the Bedsider website.

Study results indicate that Bedsider has what young adult (ages 18–29) patients are looking for in a contraceptive counseling website. Patients universally found the website informative, interactive, contemporary and easy to use and access. They identified with the “real stories” and videos showing real women and men speaking about their personal experiences with birth control. They found the website empowering and felt they could rely on the information to make informed decisions about contraceptive options.

Staff and providers in the clinic were less optimistic about the ability of the website to meet the needs of patients. Although many providers liked the visual appeal and contemporary nature of the website, they were concerned that the website was too complicated for patients. They felt the website used too much slang and was written at too high of a reading level. Clinicians also assumed patients lacked the computer and cell phone access needed to use Bedsider. Furthermore, they felt the website did not empower women but rather provided “racy” and “smutty” material which potentially detracted from the opportunity to educate women about birth control. This is, perhaps, the most significant finding from this work: providers may be out of touch with patients and their contraceptive counseling needs. The discrepant perspectives between patients and providers regarding the legitimacy, appropriateness, usability, applicability, and empowerment of Bedsider may be an indication that while providers’ intentions are good and they believe they are providing adequate information in a professional way, that this may not be what patients want or need.

Data from the survey portion of this study showed that Bedsider increased intention to use LARC options similar to more traditional methods such as a group birth control counseling class. Furthermore, the website improved knowledge of contraceptive options. Study numbers were not adequate to suggest that one educational option is superior to the other. However, patients seemed to relate much better to the Bedsider website and thought it provided better information than that given by clinicians. Using Bedsider adjunctively to traditional clinical contraceptive counseling practices may better serve young adult patients.

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