Knowledge is necessary but insufficient to change provider attitudes about intrauterine devices for adolescents

摘要

I read with much interest the article by Kohn [1] et al. describing the results from a survey of New York City school based health center staff designed to identify barriers to intra-uterine device (IUD) provision for adolescents. I am pleased that Kohn et al. based their survey on a very similar survey my colleagues and I conducted with a national sample of family physicians in 2008 [2,3]. We too found that providers, in this case family physicians, have knowledge gaps and attitudes that likely result in missed opportunities to provide IUDs to all eligible patients including adolescents. Kohn found as we did that those providers who have better IUD knowledge and who recommend IUDs are more likely to perceive that their patients are receptive to discussing IUDs. It is encouraging that, as compared with our sample, Kohn's clinician responders appear to have better IUD knowledge. This likely reflects the secular trend of increased IUD use in the United States [4] and dissemination of research supporting the safety and efficacy of IUDs across the reproductive lifespan [5]. In fact, a recent study found that increasing IUD use in adolescents can decrease the adolescent pregnancy rate [6].