What’s Happening in the Exam Room? A Mixed-Methods Study About the Provision of Patient-Centered Contraceptive Care for Baltimore Latine Patients

Context: Patient-centered contraceptive care prioritizes patient contraceptive needs and preferences while considering important socio-political factors. Latina/e patients desire such care but experience it inconsistently. This study explores experiences of contraceptive care using quantitative and qualitative methods, including the association between patient characteristics and receipt of patient-centered contraceptive care, among a sample of Latina/e patients in Baltimore, Maryland. Methods: We quantitatively assessed experiences of patient-centered contraceptive care among Latina/e patients ages 15–45 by using the Patient-Centered Contraceptive Counseling measure (PCCC) and a visit-satisfaction measure. Audio-recordings of visits were coded using the Four Habits Coding Scheme (4HCS), a measure of patient-centered communication between patients and clinicians. Analyses between patient characteristics and PCCC, 4HCS, and patient satisfaction scores were bivariate and exploratory. Qualitative interviews with a patient subset further characterized experiences. Results: A total of 52 visits, including patient surveys, were analyzed; a subset of 29 patients participated in interviews. A majority of patients (63.5%) reported the highest possible PCCC ratings, and 85% reported the highest level of satisfaction with their contraceptive counseling visits. Researcher-reported 4HCS scores were lower than patient-reported measures; scores for one particular habit of the 4HCS were significantly lower for Spanish-preferring and uninsured patients. The discrepancy between patient-reported PCCC and satisfaction ratings and researcher-reported 4HCS scores is contextualized by interviews in which patients reported that counseling received during the study period focused on their contraceptive preferences and involved interactions with friendly, communicative clinicians/staff, which contrasted with previous, lower quality, healthcare experiences. Conclusions: Positive experience and satisfaction ratings of Latina/e patients in the context of suboptimal patient-centered care (PCC) on audio-recordings reveal somewhat of a discrepancy between self-report and observation. Provision of contraceptive patient-centered care requires attention to both patient-reported experiences and measures using direct observations, as well as a more robust understanding of how PCC is conceptualized by patients and delivered by clinicians.