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Introduction <p>Although contraceptive counseling increasingly emphasizes patient preferences, limited research has explored whether distinct multidimensional profiles of contraceptive method characteristics—including sexual acceptability—exist among users or how these profiles vary across sociodemographic groups. Preferences beyond efficacy and safety, such as those related to sexual experience, relational dynamics, and social alignment, may play critical roles in contraceptive decision-making.</p> Methods <p>We analyzed baseline survey data from the HER Salt Lake Contraceptive Initiative (2015–2020; <i>N</i> = 3,319). Using a 75% construction subsample (<i>N</i> = 2,734), we applied exploratory latent class analysis (ELCA) to identify contraceptive user profiles based on nine binary-coded method characteristic preferences: absence of hormones, partner acceptability, does not interrupt sex, does not reduce libido, alignment with religious beliefs, friend recommendation, efficacy, side effects, and safety. We then used chi-square tests and one-way ANOVA to examine bivariate associations between latent class membership and sociodemographic characteristics.</p> Results <p>ELCA revealed four distinct classes: (1) <i>Intimacy-Aligned Effectiveness Choosers</i>, (2) <i>Effectiveness-Only Optimizers</i>, (3) <i>Risk and Hormone-Averse Effectiveness Optimizers</i>, and (4) <i>All-Attribute Considerers</i>. All groups prioritized effectiveness and safety but differed in the extent to which they valued sexuality-related, hormonal, social, and relational attributes. Class membership varied significantly by race/ethnicity, sexual orientation, education, income, pregnancy intentions, and other demographic factors.</p> Conclusion <p>Contraceptive users demonstrate diverse and complex preferences that extend beyond traditional efficacy and safety considerations. Sexual acceptability and hormonal concerns, among others, meaningfully shape user profiles and should be treated as legitimate influences on method choice.</p> Policy Implications <p>Our findings support the need for individualized, patient-centered contraceptive counseling that incorporates sexuality-related concerns, hormonal sensitivity, and sociocultural context. Moving beyond tiered-effectiveness models toward shared decision-making frameworks can better promote reproductive autonomy and method satisfaction.</p>

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Developing Contraceptive Decision-Making Profiles via Latent Class Analysis: Understanding User Priorities Across Contraceptive Attributes

  • 期刊论文

  • 发表日期：

    2026年5月14日

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  • Jessica N. Sanders,
  • Douglas Routh,
  • Bethany Everett,
  • Kelsey Wright,
  • David K. Turok,
  • Jenny A. Higgins

摘要

Introduction

Although contraceptive counseling increasingly emphasizes patient preferences, limited research has explored whether distinct multidimensional profiles of contraceptive method characteristics—including sexual acceptability—exist among users or how these profiles vary across sociodemographic groups. Preferences beyond efficacy and safety, such as those related to sexual experience, relational dynamics, and social alignment, may play critical roles in contraceptive decision-making.

Methods

We analyzed baseline survey data from the HER Salt Lake Contraceptive Initiative (2015–2020; N = 3,319). Using a 75% construction subsample (N = 2,734), we applied exploratory latent class analysis (ELCA) to identify contraceptive user profiles based on nine binary-coded method characteristic preferences: absence of hormones, partner acceptability, does not interrupt sex, does not reduce libido, alignment with religious beliefs, friend recommendation, efficacy, side effects, and safety. We then used chi-square tests and one-way ANOVA to examine bivariate associations between latent class membership and sociodemographic characteristics.

Results

ELCA revealed four distinct classes: (1) Intimacy-Aligned Effectiveness Choosers, (2) Effectiveness-Only Optimizers, (3) Risk and Hormone-Averse Effectiveness Optimizers, and (4) All-Attribute Considerers. All groups prioritized effectiveness and safety but differed in the extent to which they valued sexuality-related, hormonal, social, and relational attributes. Class membership varied significantly by race/ethnicity, sexual orientation, education, income, pregnancy intentions, and other demographic factors.

Conclusion

Contraceptive users demonstrate diverse and complex preferences that extend beyond traditional efficacy and safety considerations. Sexual acceptability and hormonal concerns, among others, meaningfully shape user profiles and should be treated as legitimate influences on method choice.

Policy Implications

Our findings support the need for individualized, patient-centered contraceptive counseling that incorporates sexuality-related concerns, hormonal sensitivity, and sociocultural context. Moving beyond tiered-effectiveness models toward shared decision-making frameworks can better promote reproductive autonomy and method satisfaction.