Adapting LARC education based on culture

Adapting LARC education based on culture | Image Credit: © (JLco) Julia Amaral - © (JLco) Julia Amaral - stock.adobe.com.

Online education about long-acting reversible contraceptives (LARCs) should be adapted for different culturally and linguistically diverse (CALD) backgrounds, according to a recent study published in Health Promotion Journal of Australia.

Women of CALD backgrounds often employ less effective contraceptive methods, increasing the risk of unintended pregnancy. Unintended pregnancy can lead to social, emotional, and medical consequences, along with socioeconomic problems.

LARC, including intrauterine devices and the subdermal hormonal implant, are the most effective contraceptives for stopping unintended pregnancy. Research has indicated LARC preference in young women can increase from watching an online educational video.

There is little data on how online educational videos on LARCs should be modified for women of CALD backgrounds, or if videos on LARCs in their current state will be effective in women in these populations. Investigators conducted a study to determine what systemic enablers and barriers to LARC should be addressed in CALD backgrounds.

Participants included female individuals aged 18 to 44 years and from a Middle Eastern, Indian, or Chinese background, as the Australian 2012 Census indicated these cultural groups were among the most populous non-English speaking backgrounds. All participants of the study were capable of speaking English.

Recruitment was accomplished through targeted social media advertisements across 10 Facebook groups. These groups were frequented by the study’s target demographic. Those who clicked on the advertisement were brought to an explanatory statement, survey of personal details, and consent form.

Semi-structure telephone interviews based on Andersen's model of health service utilization were used to gather qualitative data. This allowed investigators to determine personal and systemic enablers and barriers to LARC which could be discussed in educational videos. 

NVivo12 software was used to transcribe the interviews, with data extraction performed by independent researchers. Thematic analysis began with comprehensive active reading of the data, followed by generation of codes then themes, then refining and defining of themes.

Six women from each cultural group were interviewed. Of the study participants, 72% were aged under 30 years and 78% lived in Victoria. There were 3 themes identified in the data: tailor content to address cultural issues, optimize delivery approaches, and deliver to other people involved in reproductive decision-making.

Cultural issues to address included general knowledge about menstruation, the low efficacy of natural contraceptive methods, the ability of LARCs to be used covertly, the cost and approach to access, and misconceptions that LARC leads to abortion or that hormones damage the body.

Approaches to optimize delivery include translation into ethnic languages, educational delivery by female same-culture doctors, and dissemination through schools and culturally specific web platforms. Other people involved in reproductive decision-making include peers, partners, parents, and community leaders.

These findings indicated stigma against LARCs in CALD backgrounds. More covert methods of accessing LARCs could allow women in these populations to access them without their friends and family knowing.

Data also indicated the importance of cost and subsidized methods for women of CALD backgrounds, conveying importance for promoting information about the cost and methods of accessing LARCs. In cultures where myths that hormones are inherently bad, LARC education should emphasize the safety of hormones to counter these myths.

Different adaptations were needed depending on the culture. Investigators concluded online interventions should be translated, available to men and women of a wide age range, and include personal anecdotes on LARC use for Chinese women.

Reference

Liu R, Mazza D, Li CK, Subasinghe AK. What do women need to know about long-acting reversible contraception? Perspectives of women from culturally and linguistically diverse backgrounds. Health Promot J Austr. 2023. doi:10.1002/hpja.743