"I Don't Even Understand How They Function": Contraception Information, Motivation, and Behavioral Skills Among Women Experiencing Homelessness.

Background: Women experiencing homelessness have higher rates of unintended pregnancies than stably housed women. Given that some of this may be attributed to nonuse or inconsistent use of contraception, we explored the behavioral cognitions for contraceptive use among women experiencing homelessness. The Information-Motivation-Behavioral Skills (IMB) model can examine health behavior cognitions, while acknowledging the macro-level context. Therefore, this study explored the IMB characteristics related to contraception use among women experiencing homelessness.

Methods: We conducted interviews (n = 19) among pregnancy-capable women 18-45 years old experiencing homelessness. We recruited women between 2019 and 2020 in North Texas. Interviews were thematically analyzed based on the IMB framework.

Results: The mean age of women in the study sample was 33.4 years (SD = 7.6). In the information construct, most women were aware of different contraceptive methods; however, many desired to learn more about the side effects. For motivation, most women had a positive attitude toward their current contraception, but their motivation to use a type of contraceptive method depended on side effects and comfort with the method. Additionally, their trusted social connections influenced their contraception decisions. When examining behavioral skills, uncertainty of being able to obtain contraception was a barrier, especially with macro-level context related to lack of adequate insurance coverage and transportation.

Conclusions: Improving knowledge about side effects of contraceptive methods, addressing misconceptions, and increasing accessibility to contraceptive methods by providing transportation and financial assistance while maintaining reproductive autonomy may be effective strategies to improve equitable access to contraception and reduce unintended pregnancies among this population.