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Barriers to diaphragm use: the views of advanced practice nurses
  1. Andrzej Kulczycki, PhD, Associate Professor1,
  2. Haiyan Qu, PhD, Research Assistant Professor2,
  3. Richard M Shewchuk, PhD, Professor2 and
  4. Penelope M Bosarge, MSN, FAANP, Manager and Instructor3
  1. Program in Maternal and Child Health, Department of Health Care Organization … Policy, University of Alabama at Birmingham, Birmingham, AL, USA
  2. Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
  3. Women's Health Nurse Practitioner Option, UAB School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
  1. Correspondence to Dr Andrzej Kulczycki, Department of Health Care Organization … Policy, Maternal and Child Health Concentration, University of Alabama at Birmingham, 320 Ryals School of Public Health, 1665 University Boulevard, Birmingham, AL 35294-0022, USA. E-mail: andrzej{at}uab.edu

Abstract

Background and methodology Women have used the contraceptive diaphragm for decades. Although use has recently declined, the diaphragm may find a new role in STI/HIV and dual-prevention programmes when microbicides become available. We developed a questionnaire to examine seven provider issues identified as possible barriers to diaphragm use among advanced practice nurses (APNs) specialising in women's health. The perceived degree to which each issue represented a barrier was examined. Non-parametric correlations were calculated between diaphragm fitting history, demographic and practice characteristics, and the response ratings for each issue.

Results Responses were analysed for 204 APNs who averaged 15 years' experience in women's health care; 87% had fitted a diaphragm at least once, but 40% had not prescribed one in the past year. The degree to which each issue was perceived as a barrier varied. Based on respondents' ratings of a 'more than moderate barrier,' diaphragm non-promotion by women's health providers, effectiveness doubts, unfamiliarity and lack of access to educational materials were more often perceived as impeding diaphragm use. Other results indicated that APNs with recent diaphragm fitting history perceived five of the seven issues to be less of a barrier: non-promotion by women's health providers, lack of access to educational materials and to a fitting set, unfamiliarity, and inadequate reimbursement.

Discussion and conclusions Formulation of successful strategies to reintroduce the diaphragm will depend on better identification and understanding of provider-perceived barriers. This paper offers new insights about such barriers and guidance for the development of strategies for diaphragm reintroduction.

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