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Introduction: In South Carolina, 50% of all pregnancies are unintended. Intrauterine devices (IUDs) and the implant are recommended as top-tier contraceptive options for all women and adolescents. The Whoops Proof S.C. campaign was evaluated to determine if women (ages 18 to 29) who do not intend to become pregnant in the next year report greater awareness of and positive regard for IUDs and the implant after exposure to a multi-channel campaign., Methods: A pair-matched group pretest-posttest quasi-experimental design was utilized. A total of 1,439 women responded to the pretest survey (May-July 2016) and 1,534 responded to the posttest survey (October-November 2016) in four South Carolina counties. Statistical analysis include paired-sample and independent t-tests and one-way ANOVA tests for variance., Results: At posttest, intervention county participants were significantly more likely to recall messaging and to report receiving contraceptive information from Whoops Proof S.C (t(1533)= - 8.466, p < .0001). Participants who saw ads more than once per week reported a significant increase in awareness of IUDs and the implant (F(6,1532) = 5.571; p < .001). Participants in intervention counties reported a significant increase in positive attitudes toward IUDs (t(616) = - 1.740; p = .041) and the implant (t(603)= - 1.665; p = .048)., Discussion: The Whoops Proof S.C. campaign offers strategies to campaign planners and health care providers to optimize exposure and recall frequency to increase awareness of and positive regard for highly effective contraceptive methods. Campaign planners should test messages and focus on communication channels to increase engagement and avoid saturation.

Background: \Most college women use the combined oral contraceptive pill (COC) despite more effective long-acting reversible contraceptive (LARC) methods (e.g., IUDs and implant) being available. Resistance to change methods may be impacted by how a woman identifies with being a COC-user., Methods: Data were collected via 186 web-based surveys distributed to female students attending a university in the southeastern United States (Mean age = 20.0 ± 1.; range = 18-22). Structural equation modeling (SEM) determined TPB fit in understanding LARC intention., Results: SEM results received acceptable fit (χ2 (670, N = 186) p < 0.01, Comparative Fit Index (CFI) of 0.84, and Normative Fit Index (NFI) of 0.75). A Root Mean Square Error of Approximation (RMSEA) of 0.09 was produced, with a 90% confidence interval of 0.08 to 0.09. Including self-identity in the model yielded similar fit, with χ2 (866, N = 186) p < 0.01, CFI of 0.83, and NFI of 0.73. Self-identity and attitude pathways were significant (p < 0.01) toward intention, extending the TPB model., Conclusions: The TPB proved to be acceptable in understanding COC users' intention to obtain LARC. Results provide direction for LARC messaging tailored toward COC users and self-identity.

Introduction: Approximately 80% of college-aged women are at risk of unintended pregnancy. The American College of Obstetricians and Gynecologists recommends long-acting reversible contraceptive (LARC) methods, including intrauterine devices (IUDs), as first-line pregnancy prevention for adolescents and young women. Yet, less than 5% of 15- to 19-year-old women using a method of contraception use LARC. Limited research explores young women's concerns about IUDs., Methods: As part of a larger women's health research study, researchers conducted 53 in-depth interviews with women, aged 18 to 24 years enrolled in a midsized liberal arts college in the southeastern United States. Analytical techniques from the grounded theory approach were used to code line-by-line and identify themes emerging from these data., Results: Fear of causing harm or infertility through IUD use emerged as a significant barrier to uptake. Negative and often unfounded beliefs about IUDs led to silence and limited observability of IUDs in daily life and health care contexts. Identity as a fertile woman emerged as an antecedent factor to the compatibility of IUDs with participants' values and beliefs., Discussion: The link between fear of infertility and perceived identity was found to be a major factor in young women's contraceptive decision making. In order to increase uptake of IUDs, the beliefs of women must be addressed., (© 2016 by the American College of Nurse-Midwives.)

Increasing access to long-acting reversible contraception (LARC), including the intrauterine device and the implant is a public health and clinical imperative to reduce rates of unintended pregnancy. In 2012, the American College of Obstetricians and Gynecologists recommended these methods for all women, including adolescents. Little research explores why young women reject these safe, effective contraceptive methods. A total of 53 women aged 18-24 years completed in-depth interviews. Analytical techniques from the grounded theory approach were used to identify patterns and themes across the data. Participants initiated hormonal contraception for "the pill's" beneficial side effects and believed a myth of perfect use, which constructed a false choice of LARC methods. Barriers to LARC options included access, medical resistance, and cost. Participants described a sense of unease about methods perceived as "alien." These women underestimated the risks of oral contraceptive pills and overestimated the risks of long-acting reversible contraception, including infertility. The myth of perfect use emerged as participants wanted to be in control by taking "the pill" every day; however, many described imperfect adherence. Findings include strategies for public health professionals and health care providers to distribute satisfactory and effective contraception for young women. Effective health communication campaigns will emphasize the desirable side effects, safety and increased effectiveness of LARC methods.