Using the theory of planned behavior and self-identity to explore women's decision-making and intention to switch from combined oral contraceptive pill (COC) to long-acting reversible contraceptive (LARC)

Abstract

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.