Contraceptive counselling in 3 Canadian bariatric surgery clinics: a multicentre qualitative study of the experiences of patients and health care providers

Article Figures & Tables

Table 1:

Participant demographic characteristics

Characteristic	No. (%) of participant group
Patients (n = 16)
Age, yr
20–29	3 (19)
30–39	6 (37)
40–45	7 (44)
Type of surgery received
Roux-en-Y gastric bypass	11 (69)
Sleeve gastrectomy	5 (31)
Patient education
Grade 12 or below	3 (19)
University/college degree or more	13 (81)
Health care provider (n = 11)
Area of practice^*
Atlantic Canada	0
Central Canada	6 (55)
Western Canada	4 (36)
Not reported	1 (9)
Role in clinic
Surgeon	2 (18)
Physician (nonsurgeon)	2 (18)
Nurse	7 (64)
Primary surgery performed in clinic^†
Roux-en-Y gastric bypass	7 (63)
Sleeve gastrectomy	3 (27)

↵* Atlantic Canada includes Newfoundland and Labrador, New Brunswick, Nova Scotia and Prince Edward Island. Central Canada includes Quebec, Ontario and Manitoba. Western Canada includes Saskatchewan, Alberta and British Columbia.
↵† One participant reported an equal split of procedures.

Table 2:

Summary of qualitative themes

Theme	Subtheme
Missing information	Avoiding conception Choosing contraception Changing gynecologic health
Making assumptions	Who to counsel Who does counselling “I don’t need counselling”
Improving experiences	Content Repetition Format

Table 3:

Theme of missing information

Quotation number	Quotation
1	That [the patient orientation manual] is what we call our bible. That’s what we go back to and refer to all the time. (Patient 15)
2	It was literally one line on a slide. (Patient 5)
3	But they didn’t talk about any contraceptives or way to prevent it or anything. (Patient 7)
4	I mean nothing’s really been clarified as for the pill or whether to go off it or what … nobody has given me any other options. (Patient 15)
5	Like are my periods going to be different, because like it’s supposed to be coming up within the week … is it going to be on time like it was before? (Patient 5)
6	Interviewer: Was there any training? Participant: No, none. (HCP 4)
7	The other NPs [nurse practitioners] may not have the same familiarity with contraception, so I think that’s a barrier as well. Not to say that they don’t know about it, but there isn’t as much ease with it. (HCP 4)
8	I think that it could definitely be missed … I mean hopefully I don’t miss it very often, but it’s kind of up to the nurse that’s doing the assessment to remember to tell them. (HCP 6)

Table 4:

Theme of making assumptions

Quotation number	Quotation
1	I don’t know if at that point they assume that I’m good and I know some things and I’m taken care of and so they don’t continue the conversation. (Patient 4, who reported that she had an intrauterine device before her surgery)
2	I know some people get embarrassed talking about having sex and everything that goes along with it, but I think it would be good; they don’t even discuss how long you should abstain. (Patient 13)
3	You don’t want to be on the pill thinking you’re fine and then all of sudden you get pregnant with your fourth child. (Patient 2)
4	If their husbands have had vasectomies … I don’t counsel any further. (HCP 11)
5	I don’t know what the nurses are telling them about what methods they can use. (HCP 2)
6	Often we get that “well I haven’t ovulated” — that’s not a problem. (HCP 9)

Table 5:

Theme of improving experiences

Quotation number	Quotation
1	I believe that a handout definitely would be helpful, something tangible. (Patient 12)
2	But just a reminder it’s really important that if you do this [surgery] that you shouldn’t be considering getting pregnant … because it’s a really emotional time … and you might not be thinking. (Patient 1)
3	Because, you know, knowledge is power. (Patient 9)
4	Having the various [contraception] options and then having reasons why birth control may not work well … but also talking about how their fertility changes when they lose weight. (HCP 4)