Contraceptive compliance

Patterns of Contraceptive Consistency among Young Adult Women in Southeastern Michigan: Longitudinal Findings Based on Journal Data

BACKGROUND

We aimed to determine patterns of contraceptive consistency among heterosexually active, young adult women who do not desire pregnancy, and to identify factors associated with these patterns.

METHODS

We analyzed longitudinal data from a population-based study of young adult women aged 18 and 19 who were representative of a single county in southeastern Michigan. Using multinomial logistic regression, we identified associations between contraceptive consistency (dependent outcome) and sociodemographic characteristics and personal factors.

FINDINGS

We categorized women into three patterns of contraceptive consistency: 1) always consistent (40%; reference group), 2) sometimes consistent (49%), 3) never consistent (11%). Not being employed was associated with increased odds of being sometimes consistent (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1-2.2) and never consistent (OR, 1.9; 95% CI, 1.1-3.4). Those who reported a grade point average of 3.0 or less were more likely to be never consistent (OR, 2.5; 95% CI, 1.2-5.3). Women in a serious relationship had a two times greater odds of being sometimes consistent. Among always consistent users, the oral contraceptive pill was most often used (55%); only 4% used the intrauterine device or implant. Sometimes consistent and never consistent users most frequently relied on condoms (35%) and withdrawal (68%), respectively.

CONCLUSIONS

This analysis of longitudinal data revealed that the majority of young adult women inconsistently used short-acting or coital-specific methods; few used the most effective, long-acting methods. Interventions to improve contraceptive consistency among young adult women should include periodic assessments of personal factors (i.e., work, school, relationships) and promotion of long-acting reversible contraceptive methods when appropriate.

The structure of contraceptive education and instruction within nurse led family planning clinics: a grounded theory study

AIMS

This study aimed to explore and analyse how nurses instruct women in contraceptive use during consultations in family planning clinics to produce a grounded theory of contraceptive education.

BACKGROUND

Nurses play a key role in instructing women how to use contraception in family planning clinic consultations. These one-to-one situations are encounters where women are taught how to use contraceptive methods effectively. However, very little is known about the nature of these consultations.

DESIGN

A qualitative study using a grounded theory approach was used.

RESULTS

Three linked 'core categories' emerged from the data analysis. Firstly, women are educated about their body and how it responds to contraception: 'reproductive education'. This core category is closely linked to 'surveillance' where women are taught to monitor their reproductive health and to 'contraceptive regimen' where women are instructed in techniques to successfully use a contraceptive method. Together these three core categories present a grounded theory of 'contraceptive education'.

CONCLUSIONS

Nursing practice in this important area of women's health care is complex and requires skilled practitioners. This study presents unique empirical data into how nurses conduct one-to-one consultations with women - providing a novel insight into how contraception is explained in clinical situations. Key issues for practice from the data were the lack of a balance when discussing side effects, the rigidity of some instructions and the lack of recognition of risk from sexually transmitted infection.

RELEVANCE TO CLINICAL PRACTICE

Nurses working in sexual health need to ensure that women understand the often complex instructions they provide and that rigid instruction be occasionally amended to enable some flexibility. The manner in which side-effects are discussed should also be balanced. Nurses need to address the risk of sexually transmitted infections more substantially in contraceptive discussions.

Intimate partner violence and women's contraceptive use

Intimate partner violence has been hypothesized as a factor associated with women's risk for problems in contraception use or access. This article explores differences in contraceptive use between abused and nonabused women, using a case-control study of 225 women. Women experiencing physical and emotional abuse were more likely to report not using their preferred method of contraception in the past 12 months compared with nonabused women (OR = 1.9; 95% CI = 1.0 to 3.7). Health care providers need to consider how intimate partner violence may influence their patients' use of contraceptives, which has implications for the high risk of unintended pregnancies among abused women.

The Pill: Time for a New Look

Based on the popularity of the birth control pill (“The Pill”), its economic importance, and its role as a daily component of the modern woman's environment and lifestyle, we decided to study pill usage habits and the cognitive and behavioral causes of noncompliance. Our findings led us to suggest design solutions to promote consistency of use and improve attitudes toward the pill. We conducted a field study of birth control pill dispensers, performed a task analysis of pill taking, and distributed a detailed questionnaire among 380 Israeli women. Our suggestions for improving compliance include incorporating memory aids, creating better packaging design, and reducing the medical stigma of the pill by positioning it as a designed, daily lifestyle item.

Nurses' discourse in contraceptive prescribing: an analysis using Foucault's 'procedures of exclusion'

AIM

This paper is a report of an analysis of the discourse about contraceptive efficacy and side effects used by nurses when prescribing contraception.

BACKGROUND

All women seeking contraception should be informed of the efficacy and potential adverse effects of the particular method they are considering. This information facilitates an informed choice. Women also require this information in order to monitor for any side effects. Paradoxically, side effects are also a key factor in reducing adherence with contraceptive regimens. However, there is no literature that explores specifically how this issue is addressed in clinical consultations, or places these practices in a theoretical context.

METHOD

Forty-nine consultations between nurses and women in sexual health clinics were audio-recorded during 2002. Data were subject to a discourse analysis using Foucault's 'procedures of exclusion' to explore the discursive construction of contraceptive efficacy and side effects

FINDINGS

The nurses employed specific discursive strategies when discussing contraception. When addressing efficacy, discourse centred on medico-statistical facts, but side effects were described in lay terms that minimized their severity. Nurses contextualized contraceptive side effects within potential problems that women might experience in pregnancy, and also attempted to 'normalize' contraceptive-related problems.

CONCLUSION

Discourse and its deployment play a key role in practitioner-client relationships that sexual health nurses need to become more aware of how they discuss clinical issues about contraception with women. Clinical data on contraceptive side-effects are present in the literature, and it is important that sexual health nurses use this to help women make truly informed decisions.

Same-day initiation of the transdermal hormonal delivery system (contraceptive patch) versus traditional initiation methods

INTRODUCTION

Published comparisons of oral contraceptive pill (OCP) initiation methods demonstrate that OCP initiation at the office visit ("Quick Start") resulted in higher continuation rates into the second cycle. This trial was performed to investigate whether Quick Start with the contraceptive patch would provide similar results.

MATERIALS AND METHODS

Sixty women were randomized to initiate use of the contraceptive patch using Quick Start (Group 1, n=30) or on the first day of their next menses (Group 2, n=30). Telephone contact at 6 weeks occurred to ensure that the second cycle had been initiated. A single follow-up visit was scheduled after completion of the third patch cycle.

RESULTS

Continuation rates for Groups 1 and 2 were 97% and 93% (p=1.0), respectively, into the second cycle, and 93% and 90%, respectively, into the third cycle (p=1.0). Only approximately half of the subjects planned to continue using the patch after the study.

CONCLUSION

Quick Start for the contraceptive patch did not improve continuation rates into the second or third cycle.

The impact of improved compliance with a weekly contraceptive transdermal system (Ortho Evra®) on contraceptive efficacy

OBJECTIVE

The contraceptive efficacy of perfect dosing cycles and imperfect dosing cycles has not been described previously. Method compliance determines the proportion of perfect and imperfect dosing cycles, and together can form the basis for evaluating differences in efficacy based on differences in compliance.

MATERIALS AND METHODS

The transdermal contraceptive delivery system (Ortho Evra) has been studied in a North American randomized trial vs. an oral contraceptive (OC) and in total has been evaluated in 3319 women in contraceptive clinical trials. This article explores the impact of perfect vs. imperfect compliance with the contraceptive method on contraceptive efficacy. Previously published data for a transdermal system (Patch, n = 812) and OC (Triphasil, n = 605) users from the North American comparative study were reanalyzed to determine the effect of imperfect use on the contraceptive efficacy of the different methods.

RESULTS

Contraceptive efficacy was significantly better (p = 0.007) in cycles with perfect dosing (Pearl Index = 0.83) compared to those with imperfect dosing (Pearl Index = 6.32) for both methods. This difference is homogeneous (p = 0.62) across the Patch and OC groups. Pooled data for all Patch users confirm that perfect dosing cycles are associated with significantly better efficacy than imperfect dosing cycles (p = 0.047). In addition, compliance did not vary by age in the pooled Patch data, which are in agreement with the previously published Patch data from the comparative study. In the comparative study, the percentage of cycles with perfect dosing was significantly higher with the Patch than with the OC (88.7% vs. 79.2%, p < 0.001), and was consistently high in all age groups (range, 89.6-91.8%). By contrast, among OC users, the percentage of cycles with perfect dosing increased with increasing age (p < 0.001) from 67.7% in users aged 18-20 years to more than 80% in those aged 30 years and older.

CONCLUSION

In conclusion, deviations from perfect use (whether corrected or not) of a transdermal contraceptive system and of an OC increase contraceptive failures by approximately 5-10-fold when compared to perfect use. The weekly change schedule of the transdermal contraceptive delivery system is associated with a significantly greater proportion of cycles in which there is perfect dosing compared to an OC.

Oral contraceptives: an update on health benefits and risks

OBJECTIVE

To review the health benefits and risks of oral contraceptives, with an emphasis on emerging noncontraceptive benefits and the pharmacist's role in promoting safe and effective use of these widely prescribed medications.

DATA SOURCES

Published articles identified through MEDLINE (1995-2001) using the search terms oral contraception, neoplasms, cardiovascular disease, menstrual cycle, and other pertinent subject headings. Additional articles and books were identified from the bibliographies of the retrieved articles.

DATA SYNTHESIS

Combined oral contraceptives (COCs), which contain synthetic estrogen and progestin, are the second most common form of birth control for women after sterilization. When taken properly, COCs are highly effective, with a pregnancy rate of 0.1% among perfect users. Also, a growing body of evidence points to multiple noncontraceptive benefits of COCs, including protection from several types of cancer and a variety of gynecologic benefits, such as reduced menstrual bleeding irregularities and fewer ectopic pregnancies. COCs are one of the most studied classes of medications, and they have been found to have an excellent safety profile in nonsmoking healthy women. They may be used continuously until menopause. For women with coexisting medical conditions or other special circumstances, the risks and benefits of COCs must be carefully evaluated before use.

CONCLUSION

More than 40 years after their introduction, COCs remain the leading form of hormonal contraception. By assessing patients' contraceptive needs, evaluating their risk factors, and providing sensitive and thorough counseling, pharmacists can help ensure the safe and effective use of these medications.