Contraceptive counselling and factors affecting women's contraceptive choices: results of the CHOICE study in Austria

Characteristics of good contraceptive counselling - An interview study

OBJECTIVE

One key component in preventing unplanned pregnancies is to provide effective contraceptive counselling. This study aimed to investigate what characterises good contraceptive counselling from the woman's perspective.

METHODS

A qualitative study with a phenomenological approach. Twenty-four women aged 15-45 participated in semi-structured, individual, face-to-face interviews that lasted, on average, one hour. Data were analysed by latent content analysis.

RESULTS

One overall theme emerged, person-centred contraceptive counselling - an interactive process, with three main categories: (i) a trustworthy healthcare provider, (ii) creating a liaison and (iii) the right time and place.

CONCLUSIONS

The healthcare provider's attributes as well as what happened between the healthcare provider and the woman, and the surrounding context, had a bearing on the women's descriptions of good contraceptive counselling. The process of the counselling was described as more important than the actual outcome; thus, healthcare providers need to be aware that this seemingly straightforward consultation is rather multi-layered and has great health promoting potential.

Values and preferences for contraception: A global systematic review

OBJECTIVE

To identify and synthesize original research on contraceptive user values, preferences, views, and concerns about specific family planning methods, as well as perspectives from health workers.

STUDY DESIGN

We conducted a systematic review of global contraceptive user values and preferences. We searched 10 electronic databases for qualitative and quantitative studies published from 2005 to 2020 and extracted data in duplicate using standard forms.

RESULTS

Overall, 423 original research articles from 93 countries among various groups of end-users and health workers in all 6 World Health Organization regions and all 4 World Bank income classification categories met inclusion criteria. Of these, 250 (59%) articles were from high-income countries, mostly from the United States of America (n = 139), the United Kingdom (n = 29), and Australia (n = 23). Quantitative methods were used in 269 articles, most often cross-sectional surveys (n = 190). Qualitative interviews were used in 116 articles and focus group discussions in 69 articles. The most commonly reported themes included side effects, effectiveness, and ease/frequency/duration of use. Interference in sex and partner relations, menstrual effects, reversibility, counseling/interactions with health workers, cost/availability, autonomy, and discreet use were also important. Users generally reported satisfaction with (and more accurate knowledge about) the methods they were using.

CONCLUSIONS

Contraceptive users have diverse values and preferences, although there is consistency in core themes across settings. Despite the large body of literature identified and relevance to person-centered care, varied reporting of findings limited robust synthesis and quantification of the review results.

Strategies to Increase Postpartum Contraception in Palu City

BACKGROUND: Fertility is contributed to the high birth rate, mortality, and migration. One effort to control the birth rate is through the family planning program, using contraceptives by couples of childbearing age. The family planning program regulates the distance between mothers’ pregnancies, prevents early or late age pregnancies, has quality reproductive health, and reduces maternal mortality. AIM: This study aims to assess the effectiveness of the balanced family planning counseling strategy (BFP-CS) educational model on changes in postpartum contraception behavior in pregnant women. METHODS: The research used a quasi-experiment design with a non-randomized pre-test and post-test design, with a control group design. The study consisted of one intervention group (Talise Public Health) and one control group (Singgani Public Health), Palu city, with a purposive sampling technique of 43 respondents per group. Data were analyzed using univariate and bivariate. RESULTS: The results showed that there was a significant improvement in knowledge (p = 0.00), attitude (p = 0.00), intention (p = 0.00), and the use of postpartum contraceptives (p = 0.00) before and after treatment. A significant difference was revealed between intervention and control groups on knowledge (p = 0.036), attitude (p = 0.01), intention (p = 0.00), and the use of postpartum contraceptives (p = 0.00). CONCLUSIONS: Implementing the educational model of the BFP-CS could be an effective solution to improve knowledge, attitudes, intentions, and the use of postpartum contraceptives compared to the usual counseling method.

Online contraceptive discussion forums: a qualitative study to explore information provision

BACKGROUND

Women in the UK spend up to 30 years avoiding pregnancy, and effective use of contraception requires detailed information and support. Online forums offer opportunities to discuss contraception with few restrictions. Analysis of these discussions may generate learning on the information needs and preferences of their users. We analysed contraceptive discussions on forums to explore content, motivation for engaging, behaviours observed and outcomes reported.

METHODS

We selected 50 threads across five English-speaking public forums, which contained more than 1000 contraceptive-specific threads. We generated a stratified sample of these threads (n=250) and then completed a qualitative thematic analysis.

RESULTS

Forum users seek urgent help, emotional support and the detailed accounts of others. The work of posting on forums is significant and includes framing the question to generate the desired response type, managing responses and assessing their value. Conversations were consistently framed in relation to healthcare and were important for preparing for, understanding and responding to consultations. Most of the technical information was accurate or corrected within the conversation. For most users this enquiry was part of a broader decision-making process and there was no evidence that users planned to make decisions based on forum discussions alone.

CONCLUSIONS

Our analysis has implications for healthcare organisations that offer or signpost to online information on contraception. It suggests that improvements in the online 'wrap around' information are needed to help decide when to consult, prepare for the consultation, understand the information given and manage post-consultation questions.

Vaginal ring acceptability and related preferences among women in low- and middle-income countries: A systematic review and narrative synthesis

The vaginal ring (VR) is a female-initiated drug-delivery platform used for different indications, including HIV pre-exposure prophylaxis (PrEP). We conducted a systematic review of VR acceptability, values and preferences among women in low- and middle-income countries (LMIC) to inform further investment and/or guidance on VR use for HIV prevention. Following PRISMA guidelines, we used structured methods to search, screen, and extract data from randomized controlled trials (RCTs) and observational studies reporting quantitative outcomes of acceptability of the VR for any indication published 1/1970-2/2019 (PROSPERO: CRD42019122220). Of 1,110 records identified, 68 met inclusion criteria. Studies included women 15-50+ years from 25 LMIC for indications including HIV prevention, contraception, abnormal bleeding, and menopause. Overall VR acceptability was high (71-98% across RCTs; 62-100% across observational studies), with 80-100% continuation rates in RCTs and favorable ease of insertion (greater than 85%) and removal 89-99%). Users reported concerns about the VR getting lost in the body (8-43%), although actual expulsions and adverse events were generally infrequent. Most women disclosed use to partners, with some worrying about partner anger/violence. The VR was not felt during intercourse by 70-92% of users and 48-97% of partners. Acceptability improved over time both within studies (as women gained VR experience and worries diminished), and over chronological time (as the device was popularized). Women expressed preferences for accessible, long-acting, partner-approved methods that prevent both HIV and pregnancy, can be used without partner knowledge, and have no impact on sex and few side effects. This review was limited by a lack of standardization of acceptability measures and study heterogeneity. This systematic review suggests that most LMIC women users have a positive view of the VR that increases with familiarity of use; and, that many would consider the VR an acceptable future delivery device for HIV prevention or other indications.

Contraceptive use among migrant, second-generation migrant and non-migrant women seeking abortion care: a descriptive cross-sectional study conducted in Sweden

INTRODUCTION

The objective of this study was to compare ever-in life contraception use, use of contraception at current conception, and planned use of contraception after an induced abortion, among three groups of women: migrants, second-generation migrants and non-migrant women, and to compare the types of contraception methods used and intended for future use among the three groups of women.

METHODS

The cross-sectional study administered a questionnaire face-to-face to women aged 18 years and older who were seeking abortion care at one of six abortion clinics in Stockholm County from January to April 2015.

RESULTS

The analysis included 637 women. Migrants and second-generation migrants were less likely to have used contraception historically, at the time of the current conception, and to plan to use contraception after their induced abortion compared with non-migrant women. Historically, non-migrants had used pills (89%) and withdrawal (24%) while migrants had used the copper intrauterine device (24%) to a higher extent compared to the other two groups of women. Both the migrants (65%) and second-generation migrants (61%) were more likely than the non-migrants (48%) to be planning to use long-acting reversible contraception.

CONCLUSIONS

Lower proportions of contraception use were found in migrants and second-generation migrants than in non-migrants. In addition, there were significant differences in the types of contraception methods used historically and intended for future use.

Influence of structured counseling on women's selection of hormonal contraception in Israel: results of the CHOICE study

Background

The multinational CHOICE (Contraceptive Health Research Of Informed Choice Experience) study evaluated the effects of structured counseling on women’s contraceptive decisions, their reasons for making those decisions, and their perceptions of combined hormonal contraceptive (CHC) methods in eleven countries. The aim of this paper to present data from the 1,802 women participating in Israel’s CHOICE program.

Methods

Women (aged 17–40 years) who consulted their health care providers about contraception and who would consider a CHC method qualified to participate. After indicating their intended CHC method, the women received counseling about the daily pill, weekly patch, and monthly vaginal ring. After counseling, the women completed a questionnaire about their contraceptive decisions.

Results

Before counseling, 67%, 6%, and 5% of women (mean age 27 years) intended to use the pill, patch, or ring, respectively. Counseling significantly influenced the women’s CHC choice, with 56%, 12%, and 23% of women selecting the pill, patch, or ring (P<0.0001 for all contraceptive methods versus before counseling). Logistic regression analysis suggested that age significantly increased the probability of switching from the pill to the ring.

Conclusion

Although the pill was the most popular choice overall, counseling appeared to influence Israeli women’s contraceptive decisions, with significantly more women selecting the patch. More than four times as many women selected the ring after counseling than before counseling.

Women's values in contraceptive choice: a systematic review of relevant attributes included in decision aids

BACKGROUND

Women can choose from a range of contraceptive methods that differ in important ways. Inadequate decision support may lead them to select a method that poorly fits their circumstances, leading to dissatisfaction, misuse, or nonuse. Decision support interventions, such as decision aids, may help women choose a method of contraception that best fits their personal circumstances. To guide future decision aid development, we aim to summarize the attributes of contraceptive methods included in available decision aids as well as surveys and interviews of women actively choosing a contraceptive method.

METHODS

We conducted a systematic review to identify attributes of contraceptive methods that may be important to women when engaging in this decision making process. We performed a database search of MEDLINE/PubMed, Ovid EMBASE, OVID CENTRAL, Ovid PsycInfo, EBSCO CINAHL, Popline, and Scopus from 1985 until 2013 to identify decision aids, structured interviews and questionnaires reporting attributes of contraceptive options that are of importance to women. A free-text internet search was also performed to identify additional decision support tools. All articles and tools were reviewed in duplicate for inclusion, and a summary list of attributes was compiled.

RESULTS

We included 20 surveys, 1 semistructured interview report and 19 decision aids, reporting 32 unique attributes. While some attributes were consistently included in surveys/interviews and decision aids, several were included more often in decision aids as opposed to surveys/interviews (e.g., STI prevention, noncontraceptive benefits, how the method is used, requirement of a healthcare provider), and vice versa (e.g., a woman's vicarious experience with contraceptive methods). Key attributes mentioned in both surveys/interviews and decision aids include efficacy (29 total mentioned) and side effects/health risks (28 total mentioned). While a limited number of decision support tools were formally evaluated, many were not rigorously studied.

CONCLUSIONS

Many attributes were identified as potentially important to women choosing a method of contraception, but these were inconsistently included in the reviewed resources. Formal evaluation of decision support tools for contraceptive choice and involvement of users in the development process may lead to more user-centered design and implementation.

Counseling on vaginal delivery of contraceptive hormones: implications for women's body knowledge and sexual health

BACKGROUND

Healthcare providers (HCPs) have an important role in helping women select the contraceptive method that best matches their needs and lifestyle. Recent surveys outline the need of women to be informed about all available choices, including the newest methods (particularly those not requiring daily administration), such as vaginal contraception.

METHODS

The most relevant publications on combined contraceptive vaginal ring are revised in the context of counseling as an opportunity to empower women in term of vaginal health and sexual functioning.

RESULTS

HCPs should explain the main characteristics of the combined contraceptive vaginal ring including the anatomical and physiological implications that make the vagina an ideal route of hormonal administration and the basic notions about functional modifications of the vagina during reproductive life. Clinical data on the vaginal ring should be summarized with regard to efficacy, tolerability, pharmacokinetics, cycle control and user acceptability, including recent findings on extra-contraceptive benefits (also compared to other hormonal contraceptives) on the vaginal flora and on sexual function.

CONCLUSION

Vaginal contraception offers various benefits and should always be discussed during contraceptive counseling. An open dialogue about vaginal contraception will also help enhance body knowledge and sexual health.

Factors influencing women's selection of combined hormonal contraceptive methods after counselling in 11 countries: results from a subanalysis of the CHOICE study

OBJECTIVES

To investigate which characteristics of women and healthcare professionals (HCPs) were associated with changing to another combined hormonal contraceptive (CHC) method after contraceptive counselling.

METHODS

CHOICE was a cross-sectional survey in which 18,787 women were counselled about combined hormonal contraceptives, during which their contraceptive methods preferred both prior to and after counselling were recorded. In this subanalysis, characteristics associated with changing the method after counselling were determined using logistic regression models.

RESULTS

The probability of intending to change from the pill to another method was associated with being older; university-educated; being in a steady relationship; a prior unintended pregnancy; a younger HCP or one who recommended methods other than the pill. Changing to the patch was associated with a female HCP or a HCP who recommended the patch or an injectable. Changing to the ring was associated with being over 21 years; university-educated; being in a relationship; previous hormonal method use; and counselling by a female HCP, a HCP < 60 years old, or a HCP who recommended the ring or an implant. The country of residence influenced these changes in a complex pattern.

CONCLUSIONS

Women's choice of CHC methods after contraceptive counselling are influenced by their age, educational background, relationship status, prior unplanned pregnancies and country of residence, as well as age, gender and preferences of their HCP.

Women's perceptions and reasons for choosing the pill, patch, or ring in the CHOICE study: a cross-sectional survey of contraceptive method selection after counseling

Background

The European CHOICE study was a cross-sectional survey that evaluated women’s combined hormonal contraceptive choices before and after contraceptive counseling in Austria, Belgium, Czech Republic and Slovakia, the Netherlands, Poland, Sweden, Switzerland, Israel, Russia, and Ukraine. The changes in method selection before and after counseling were reported previously. In this paper we present the reasons given by the 18,787 participating women for selecting their contraceptive method of choice, as well as their perceptions about the contraceptive pill, patch, and ring after counseling.

Methods

Women with an interest in a combined hormonal contraceptive method (pill, patch, or ring) were counseled using a standardized counseling leaflet. The women completed questionnaires, which included questions on why they had selected a particular method of contraception, and the extent to which they agreed with statements about the attributes of the pill, patch, and ring. The results for each country were compared with the percentages for all countries combined by using a binomial regression model. Multiple logistic regression models were used to investigate the extent to which the probability of choosing a method was related to prespecified aspects (i.e. perceptions) of each contraceptive method.

Results

‘Easy to use’, ‘convenience’, and ‘regular menstrual bleeding’ were important selection criteria. ‘Nondaily administration’ was one of the main reasons women selected the patch or ring. ‘Daily use’ and ‘will forget to take it’ were the primary reasons for not selecting the pill, while the main reasons for not choosing the patch included ‘not discrete, visible’ and ‘can fall off’. In a small number of instances, the ring was rejected because some women don’t like to use a ‘foreign body’. Women’s perceptions influenced their contraceptive decisions: positive perceptions about a method increased the likelihood that a woman would select it. After counseling, many women associated the pill with forgetfulness, and many still did not know about the patch or ring’s key attributes. Women’s knowledge about a particular method was generally greater if they had chosen it.

Conclusions

To support informed contraceptive decision-making, healthcare professionals should realize that a woman’s view of a method’s ease of use is more important than perceived efficacy, tolerability, health benefits, or risks.