Abstract：
OBJECTIVE: To visualize contraceptive choice pathways among adolescent and young adults (AYA) designated female at birth (DFAB) as a means of exploring the relationships between current contraceptive use, desired contraceptive, and ultimately, chosen contraceptive method.
METHODS: A retrospective cross-sectional study was conducted of AYA DFAB (N=2369), aged 14-24 years, presenting for initial visit at a contraceptive clinic with standardized efficacy-based counseling. Sankey diagrams were utilized to visualize patient flow through the contraceptive decision-making process. Outcomes of interest were current contraceptive method, desired contraceptive prior to contraceptive counseling, and then chosen contraception. Chi-Square tests were conducted to quantify the strength of the relationships identified by the Sankey diagrams.
RESULTS: Sankey diagrams demonstrated a fair amount of change from current contraceptive to desired contraceptive and from current contraceptive to chosen contraceptive. A stronger relationship was evident between desired contraceptive method and chosen method; most patients did not change their desired contraceptive after receiving counseling except AYA who were undecided about their desired contraceptive who flowed variably into all available methods. Chi-Square test assessing the association between desired and chosen contraceptive method was significant at p-value <0.001, validating the patterns identified with the Sankey diagrams.
CONCLUSIONS: We identified distinct contraceptive decision-making pathways among AYA which could inform the framework for a more tailored counseling approach. These findings are aligned with national medical organizations\' recommendations for provision of non-coercive, patient-centered contraceptive counseling to promote adolescent reproductive autonomy.
METHODS: A retrospective cross-sectional study was conducted of AYA DFAB (N=2369), aged 14-24 years, presenting for initial visit at a contraceptive clinic with standardized efficacy-based counseling. Sankey diagrams were utilized to visualize patient flow through the contraceptive decision-making process. Outcomes of interest were current contraceptive method, desired contraceptive prior to contraceptive counseling, and then chosen contraception. Chi-Square tests were conducted to quantify the strength of the relationships identified by the Sankey diagrams.
RESULTS: Sankey diagrams demonstrated a fair amount of change from current contraceptive to desired contraceptive and from current contraceptive to chosen contraceptive. A stronger relationship was evident between desired contraceptive method and chosen method; most patients did not change their desired contraceptive after receiving counseling except AYA who were undecided about their desired contraceptive who flowed variably into all available methods. Chi-Square test assessing the association between desired and chosen contraceptive method was significant at p-value <0.001, validating the patterns identified with the Sankey diagrams.
CONCLUSIONS: We identified distinct contraceptive decision-making pathways among AYA which could inform the framework for a more tailored counseling approach. These findings are aligned with national medical organizations\' recommendations for provision of non-coercive, patient-centered contraceptive counseling to promote adolescent reproductive autonomy.
摘要：
目的：可视化青少年和年轻人（AYA）指定的女性出生时（DFAB）的避孕选择途径，以探索当前使用避孕药之间的关系，想要的避孕药，最终,选择避孕方法。
方法：对AYADFAB（N=2369）进行了回顾性横断面研究，14-24岁,通过标准化的基于疗效的咨询，在避孕诊所进行初次就诊。使用Sankey图来可视化避孕决策过程中的患者流量。感兴趣的结果是目前的避孕方法，在避孕咨询之前需要避孕药，然后选择避孕。进行卡方检验以量化由Sankey图确定的关系的强度。
结果：桑基图显示了从当前的避孕药到期望的避孕药以及从当前的避孕药到选择的避孕药的相当大的变化。所需的避孕方法与所选择的避孕方法之间存在着更强的关系；大多数患者在接受咨询后没有改变他们所需的避孕药，除了AYA，他们对所需的避孕药不确定，他们以各种方式流入所有可用的方法。卡方检验评估期望的和选择的避孕方法之间的关联在p值<0.001时是显著的,验证了用Sankey图识别的模式。
结论：我们在AYA中确定了不同的避孕决策途径，这可以为更量身定制的咨询方法提供框架。这些发现与国家医疗组织关于提供非强制性的建议相一致，以患者为中心的避孕咨询促进青少年生殖自主性。
方法：对AYADFAB（N=2369）进行了回顾性横断面研究，14-24岁,通过标准化的基于疗效的咨询，在避孕诊所进行初次就诊。使用Sankey图来可视化避孕决策过程中的患者流量。感兴趣的结果是目前的避孕方法，在避孕咨询之前需要避孕药，然后选择避孕。进行卡方检验以量化由Sankey图确定的关系的强度。
结果：桑基图显示了从当前的避孕药到期望的避孕药以及从当前的避孕药到选择的避孕药的相当大的变化。所需的避孕方法与所选择的避孕方法之间存在着更强的关系；大多数患者在接受咨询后没有改变他们所需的避孕药，除了AYA，他们对所需的避孕药不确定，他们以各种方式流入所有可用的方法。卡方检验评估期望的和选择的避孕方法之间的关联在p值<0.001时是显著的,验证了用Sankey图识别的模式。
结论：我们在AYA中确定了不同的避孕决策途径，这可以为更量身定制的咨询方法提供框架。这些发现与国家医疗组织关于提供非强制性的建议相一致，以患者为中心的避孕咨询促进青少年生殖自主性。
