Premium
A theoretical model of contraceptive decision‐making and behaviour in diabetes: A qualitative application of the Health Belief Model
Author(s) -
Johnson Emily,
DeJonckheere Melissa,
Oliverio Andrea L.,
Brown Kathryn S.,
Van Sparrentak Murphy,
Wu Justine P.
Publication year - 2021
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.14434
Subject(s) - medicine , health belief model , qualitative research , harm , seriousness , risk perception , type 2 diabetes , diabetes mellitus , family medicine , social psychology , perception , public health , nursing , health promotion , psychology , social science , neuroscience , sociology , political science , law , endocrinology
Abstract Aim People with diabetes have contraceptive needs that have been inadequately addressed. The aim of this qualitative study was to develop a theoretical model that reflects contraceptive decision‐making and behaviour in the setting of diabetes mellitus. Methods We conducted semi‐structured, qualitative interviews of 17 women with type 1 or type 2 diabetes from Michigan, USA. Participants were recruited from a diabetes registry and local clinics. We adapted domains from the Health Belief Model (HBM) and applied reproductive justice principles to inform the qualitative data collection and analysis. Using an iterative coding template, we advanced from descriptive to theoretical codes, compared codes across characteristics of interest (e.g. diabetes type), and synthesized the theoretical codes and their relationships in an explanatory model. Results The final model included the following constructs and themes: perceived barriers and benefits to contraceptive use (effects on blood sugar, risk of diabetes‐related complications, improved quality of life); perceived seriousness of pregnancy (harm to self, harm to foetus or baby); perceived susceptibility to pregnancy risks (diabetes is a ‘high risk’ state); external cues to action (one‐size‐fits‐all/anxiety‐provoking counselling vs. personalized/trust‐based counselling); internal cues to action (self‐perceived ‘sickness’); self‐efficacy (reproductive self‐efficacy, contraceptive self‐efficacy); and modifying factors (perceptions of biased counselling based upon one’s age, race or severity of disease). Conclusions This novel adaptation of the HBM highlights the need for condition‐specific and person‐centred contraceptive counselling for those with diabetes.