A theoretical model of contraceptive decision making and behavior in diabetes: A qualitative application of the Health Belief Model.

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 behavior 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 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 fetus or baby); perceived susceptibility to pregnancy risks (diabetes is a "high risk" state); external cues to action (one-size-fits-all/anxiety-provoking counseling versus personalized/trust-based counseling); internal cues to action (self-perceived "sickness"); self-efficacy (reproductive self-efficacy, contraceptive self-efficacy); and modifying factors (perceptions of biased counseling based upon one's age, race, or severity of disease) CONCLUSIONS: This novel adaptation of the Health Belief Model highlights the need for condition-specific and person-centered contraceptive counseling for those with diabetes.