Open Access Open Access  Restricted Access Subscription Access

The role of narratives in patient-provider discussions about contraceptive decisions

Brianna R Cusanno, Amy Estlund, Tessa Madden, Christina M Buckel, Mary C Politi


Rationale, aims and objectives: Use of contraception is essential for reducing rates of unintended pregnancy. Understanding how women acquire knowledge and develop beliefs about contraception can help providers improve person-centered contraceptive counseling and provision. In addition, investigating providers’ perspectives and strategies for contraceptive counseling may help identify strengths and weaknesses of counseling approaches. This paper explores personal and social narratives about contraception and how these narratives impact healthcare encounters and patients’ decisions.

Methods: Qualitative data were collected as part of a larger study aimed at implementing a model for patient-centered contraceptive provision in community health centers. Sixty participants (13 patients between the ages of 14-45 and 47 staff and providers) were recruited from 3 Federally Qualified Health Centers to participate in semi-structured interviews. Data were contextualized according to a taxonomy of narratives to support decision-making.

Results: Patients often learned about contraception through narratives told by social connections. Both patients and health center staff and providers identified narratives as important influences on women’s selection of contraceptive methods. These narratives sometimes caused women to be wary of specific methods. Patients primarily related outcome-based (as opposed to process- or experience-oriented) narratives. Staff and providers recognized the power of narratives, although they were sometimes frustrated by patients’ reliance on these narratives. Providers described a number of strategies for engaging with patients’ narratives during counseling sessions.

Conclusions: Our findings underscore the strong influence of narratives on women’s selection of contraceptive methods. Health narratives are a potential strategy to facilitate informed decision-making about contraception in clinical encounters and educational campaigns.


Contraception, healthcare, health services research, medical costs, narratives, patient autonomy, patient beliefs, patient-centered care, patient-centered counseling, patient-provider, patient values, person-centered healthcare, public health, shared deci

Full Text:



U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Family planning. In: Healthy People 2020. Washington D.C.

Finer, L.B. & Zolna, M.R. (2016). Declines in unintended pregnancy in the United States, 2008-2011. New England Journal of Medicine 374 (9) 843-852.

Logan, C., Holcombe, E., Manlove, J. & Ryan, S. (2007). The consequences of unintended childbearing. The National Campaign to Prevent Teen and Unplanned Pregnancy.

Trussell, J., Henry, N., Hassan, F., Prezioso, A., Law, A. & Filonenko, A. (2013). Burden of unintended pregnancy in the united states: Potential savings with increased use of long-acting reversible contraception. Contraception 87 (2) 154-161.

Dehlendorf, C., Diedrich, J., Drey, E., Postone, A. & Steinauer, J. (2010). Preferences for decision-making about contraception and general health care among reproductive age women at an abortion clinic. Patient Education and Counseling 81 (3) 343-348.

Becker, D., Klassen, A.C., Koenig, M.A., LaVeist, T.A., Sonenstein, F.L. & Tsui, A.O. (2009). Women's perspectives on family planning service quality: An exploration of differences by race, ethnicity and language. Perspectives on Sexual and Reproductive Health 41 (3) 158-165.

Dehlendorf, C., Levy, K., Kelley, A., Grumbach, K. & Steinauer, J. (2013). Women's preferences for contraceptive counseling and decision making. Contraception 88 (2) 250-256.

Blackstock, O.J., Mba-Jonas, A. & Sacajiu, G.M. (2010). Family planning knowledge: The role of social networks and primary care providers as information sources for African American women. American Journal of Sexuality Education 5 (2) 128-143.

Guendelman, S., Denny, C., Mauldon, J. & Chetkovich, C. (2000). Perceptions of hormonal contraceptive safety and side effects among low-income latina and non-latina women. Maternal and Child Health 4 (4) 233-239.

Carter, M.W., Bergdall, A.R., Henry-Moss, D., Hatfield-Timajchy, K. & Hock-Long, L. (2012). A qualitative study of contraceptive understanding among young adults. Contraception 86 (5) 543-550.

Yee, L. & Simon, M. (2010). The role of the social network in contraceptive decision-making among young, African American and Latina women. Journal of Adolescent Health 47 (4) 374-380.

Sundstrom, B. (2012). Fifty years on “the pill”: A qualitative analysis of nondaily contraceptive options. Contraception 86 (1) 4-11.

Anderson, N., Steinauer, J., Valente, T., Koblentz, J. & Dehlendorf, C. (2014). Women's social communication about IUDs: A qualitative analysis. Perspectives on Sexual and Reproductive Health 46 (3) 141-148.

Levy, K., Minnis, A.M., Lahiff, M., Schmittdiel, J. & Dehlendorf, C. (2015). Bringing patients' social context into the examination room: An investigation of the discussion of social influence during contraceptive counseling. Women’s Health Issues 25 (1) 13-21.

Bekker, H.L., Winterbottom, A., Fowler, J., Volk, R.J., Feldman-Stewart, D., Burtow, P., Shaffer, V., Jibaja-Weiss, M. & Dillard, A. (2012). Chapter E: Using personal stories. In: Volk, R. & Llewellyn-Thomas, H., eds. Update of the International Patient Decision Aids Standards (IPDAS) Collaboration's Background Document.

Hinyard, L.J. & Kreuter, M.W. (2006). Using narrative communication as a tool for health behavior change: A conceptual, theoretical, and empirical overview. Health Education & Behavior 34 (5) 777-792.

Winterbottom, A., Bekker, H.L., Conner, M. & Mooney, A. (2008). Does narrative information bias individual's decision making? A systematic review. Social Science & Medicine 67 (12) 2079-2088.

Bekker, H.L., Winterbottom, A.E., Butow, P., Dillard, A.J., Feldman-Stewart, D., Fowler, F.J., Jibala-Weiss, M.L., Shaffer, V.A. & Volk, R.J. (2013). Do personal stories make patient decision aids more effective? A critical review of theory and evidence. BMC Medical Informatics and Decision Making 13 (Supplement 2) S9.

Shaffer, V. & Zikmund-Fisher, B. (2013). All stories are not alike: A purpose-, content-, and valence-based taxonomy of patient narratives in decision aids. Medical Decision Making 33 (1) 4-13.

Politi, M.C., Estlund, A., Milne, A., Buckel, C.M., Peipert, J.F. & Madden, T. (2016). Barriers and facilitators to implementing a patient-centered model of contraceptive provision in community health centers. Contraception and Reproductive Medicine 1 (1) 21.

Madden, T., Mullersman, J.L., Omvig, K.J., Secura, G.M. & Peipert, J.F. (2013). Structured contraceptive counseling provided by the contraceptive CHOICE project. Contraception 88 (2) 243-249.

Peipert, J.F., Madden, T., Allsworth, J.E. & Secura, G.M. (2012). Preventing unintended pregnancies by providing no-cost contraception. Obstetrics and Gynecology 120 (6) 1291-1297.

Kavanaugh, M.L., Frohwirth, L., Jerman, J., Popkin, R. & Ethier, K. (2013). Long-acting reversible contraception for adolescents and young adults: Patient and provider perspectives. Journal of Pediatric and Adolescent Gynecology 26 (2) 86-95.

Proctor, E.K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C. & Mittman, B. (2009). Implementation research in mental health services: An emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health and Mental Health Services Research 36 (1) 24-34.

Creswell, J.W. (2012). Qualitative inquiry and research design: Choosing among five approaches. Thousand Oaks, CA: Sage publications.

Bailey, E.J., Erwin, D.O. & Belin, P. (2000). Using cultural beliefs and patterns to improve mammography utilization among African-American women: The witness project. Journal of the National Medical Association 92 (3) 136-142.

Cannon, K. (2006). Black womanist ethics. Eugene, OR: Wipf and Stock Publishers.

Wise, M., Han, J.Y., Shaw, B., McTavish, F. & Gustafson, D.H. (2008). Effects of using online narrative and didactic information on healthcare participation for breast cancer patients. Patient Education and Counseling 70 (3) 348-356.



  • There are currently no refbacks.