• Andrzej Kulczycki, Haiyan Qu, Penelope M Bosarge, and Richard M Shewchuk.
• Maternal and Child Health Concentration, Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama 35294-0022, USA. andrzej@uab.edu
• J Womens Health (Larchmt). 2010 Jul 1;19(7):1355-61.

BackgroundThe diaphragm is receiving renewed attention not only for its dual method potential but also because of improved design. To facilitate method re-introduction, we examined what providers think about this female-controlled barrier contraceptive.MethodsA questionnaire administered to 450 women's health nurse practitioners (NPs) asked about their practice experience and issues concerning diaphragm use. Latent class analysis (LCA) was used to identify different groups of providers, based on patterns of perceptions regarding various potential obstacles to diaphragm use. Provider profiles were further described in terms of individual and practice characteristics.ResultsThe survey achieved a 47% response rate (n = 214). Respondents saw, on average, 31 family planning patients/week; 87% had fitted a diaphragm, although only 40% had done so in the previous year. Three groups holding significantly different perceptions of obstacles to diaphragm prescription were identified. Group 1 (13% of respondents), with more practice experience in delivering women's healthcare and fitting diaphragms, considered all obstacles relatively inconsequential. Group 2 (40%) had comparatively minor concerns, whereas Group 3 (47%) perceived all issues as major obstacles. All groups stressed the diaphragm's limited promotion, and for 87% of the respondents, concerns about effectiveness and nonfamiliarity with the method also assumed more salience.ConclusionsEmerging statistical modeling approaches that go beyond standard aggregate analyses helped identify three groups of women's health nurse practitioners. By considering their diverse perceptions of potential obstacles to diaphragm use, strategies aimed at changing provider behaviors may be developed to reverse declining prescribing rates and retain the diaphragm as a viable reproductive healthcare option for women.

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