Factors in the Use of Oral Contraceptives by Young Women

Effective contraceptive use: an exploration of theory-based influences

The purpose of this study was to explore factors that influence oral contraceptive (OC) use among women in Iran using the Theory of Planned Behavior (TPB) and concept of self-efficacy (SE). The study sample consisted of 360 married OC users, aged 18-49 years recruited at public health centers of Mashhad, 900 km east of Tehran. SE had the strongest association with the intent to use after the clinic visit (r = 0.784) and with actual use (r = 0.452). Family planning self-efficacy combined with TPB variables accounted for 65% of the variance for intent and 27% of the variance in behavior. The results provide support for a theory-based approach to improved family planning care that specifically addresses more effective use. Development and evaluation of culturally appropriate public education and changes in clinical efforts designed to enhance the sense of SE are discussed.

Oral contraceptive use and female genital arousal: methodological considerations

This study explored effects of oral contraceptive pill (OCP) use on physiological sexual arousal as measured by a vaginal photoplethysmograph. Sixteen women aged 18-29 viewed audiovisual neutral and erotic stimuli before and an average of 6 weeks following the onset of OCP use. Although subjective measures of sexual arousal, including perceptions of genital arousal, significantly increased in response to erotic stimuli both before and after OCP onset, physiological sexual arousal only increased before OCP use. A comparison of individual responses before and after OCP onset reveals a much higher degree of intrasubject variability after OCP onset. We discuss these findings as they relate to OCP use as a confounding methodological variable to consider in future investigations employing vaginal photoplethysmography.

Establishing reliability and validity of an instrument measuring Jordanian Muslim women's contraceptive beliefs

We tested the psychometric properties of an instrument entitled intention to use oral contraceptive tool (IUOCT). This instrument was developed to evaluate Jordanian Muslim women's intention to use oral contraceptives (OCs). We used the theory of planned behavior (TPB) as a conceptual framework for developing the IUOCT. The internal consistency of the IUOCT ranged from .70 to .94. The stability of IUOCT ranged from.79 to.85. Factor analysis identified four factors that represented the three constructs of the TPB. The known-group technique showed significant difference between past users and nonpast users of OCs. The predictive validity analysis showed that each scale contributed to the variability in the intention.

Factors predictive of adolescents' intentions to use birth control pills, condoms, and birth control pills in combination with condoms

Using the Theory of Planned Behaviour (Ajzen, 1988) as a conceptual framework, 705 secondary school students were surveyed to identify their intentions to use birth control pills, condoms, and birth control pills in combination with condoms. Hierarchical multiple regression revealed that the theory explained between 23.5% and 45.8% of the variance in intentions. Variables external to the model such as past use, age, and ethnicity exhibited some independent effects. Attitudes were consistently predictive of intentions to use condoms, pills, and condoms in combination with pills for both male and female students. However, there were differences by gender in the degree to which subjective norms and perceived behavioural control predicted intentions. The findings suggest that programs should focus on: creation of positive attitudes regarding birth control pills and condoms; targeting important social influences, particularly regarding males' use of condoms; and developing strategies to increase students' control over the use of condoms.

The prediction of accurate contraceptive use from attitudes and knowledge

A framework of the relationship between knowledge, attitudes, and behavior was described in the context of couple's use of birth control. It was hypothesized that when knowledge of behavioral enactment is present, attitudes and beliefs about susceptibility to pregnancy will be predictive of accurate use of the diaphragm. Respondents were 111 women who participated in a three-wave panel design focusing on diaphragm use. Analyses indicated that the level of knowledge about what a woman should do to use the diaphragm correctly was high. Correct knowledge, however, did not translate into accurate behavior. Motivational factors focusing on attitudes, perceived susceptibility to pregnancy, and normative factors were also relevant.

Contraceptive use and attitudes in reunified Germany

Contraceptive use and attitudes were assessed in a random sample of 1064 German women. The majority (76%) of the sexually active, fertile women who were not pregnant and did not wish to get pregnant at the time of the survey were using very reliable contraceptive methods, namely oral contraceptives (OCs), intrauterine devices (IUDs) or sterilization. Comparison with a previous survey showed that contraceptive practice in West Germany had improved considerably since 1985. Attitudes towards the most reliable methods available (OCs, IUDs and sterilization) were found to be ambivalent. Perceived side effects and health risks were a particular matter of concern to the respondents. Although most respondents (88%) recognized that condoms prevent the transmission of AIDS, 66% of those who had occasional sexual partners did not use barrier methods. It is concluded that German contraceptive practice is reasonably effective and that if attitudes were to become more realistic the level of effectiveness could even be raised.

Contraceptive use and attitudes in Great Britain

In order to update current knowledge on contraceptive use and attitudes in Great Britain (i.e. England, Scotland and Wales), a survey was conducted among 1753 randomly selected British women aged 15-45. Replies were received from 967 women (55.2%). Seventy-three percent (73%) of fertile, sexually active women who wished to avoid pregnancy were using reliable methods of contraception, viz. oral contraceptives (OCs), intrauterine devices (IUDs) or sterilization. However, it was found that adolescents and women over 40 who wished to avoid pregnancy were, nevertheless, especially likely not to be using any contraceptive method at all. The women surveyed were concerned about weight gain, cardiovascular and cancer risks associated with OC use, and infection and infertility risks associated with IUD use. Sixty percent (60%) perceived sterilization as a major and risky surgical operation. It was concluded that contraceptive practice in Britain had not improved greatly in recent years. The latest scientific findings regarding the true advantages and disadvantages of OCs, IUDs and sterilization, therefore, need to be brought to the attention of the lay public more effectively. Special efforts need to be directed towards providing adolescents and women over 40 with proper information. Physicians and the mass media could play a considerable role in this respect.

Dimensions of the contraceptive attributes questionnaire

This article describes the development and evaluation of the Contraceptive Attributes Questionnaire (CAQ), a research instrument designed to assess the subjective importance of specific contraceptive attributes (Importance) and the perceived characteristics of specific contraceptives (Agreement). Three birth control methods are examined—the sponge, pill, and diaphragm. Factor analyses indicate that the four scales are multidimensional, and as subscales the factors have reasonable internal consistency reliability. The validity of the CAQ was established through comparisons of ratings of women who use different contraceptive methods. The women differed by user status on the ratings of the importance factors and on the ratings of the agreement factors for all three methods rated.

Measuring contraceptive values: an alternative approach

Previous assessments of individuals' values for various contraceptive consequences have employed one of four methodologies: free elicitation, direct ratings, multiple regression, or factor analysis. All four methodologies are flawed because they produce group rather than individual values, relying on rating scales, and fail to incorporate information regarding consequence trade-offs. Axiomatic conjoint measurement is proposed as an alternative methodology and used to determine individuals' values for a selected set of contraceptive consequences at two stages of the family-planning career.

The attitude/behavior discrepancy as a methodological artifact: comment on 'sexually active adolescents and condoms'

A recent questionnaire-based study published in the American Journal of Public Health found that although sexually active adolescents both believe that the use of condoms offers protection against sexually transmitted diseases and value such protection, they do not intend to use (or have their partners use) condoms. This attitude/behavior discrepancy is more apparent than real. Six methodological problems in the study are discussed in detail in order to demonstrate how the overly simplified treatment of a complex behavior can lead to invalid conclusions.

Family life education for young teens: an assessment of three interventions

The impact of three variations of a family life education (FLE) program for 172 inner-city, junior-high-level students was investigated. Variations in exposure time, instructional methods, and teacher quality led to the classification of each intervention on a general intensity dimension. Separate pretest-posttest nonequivalent comparison group designs were utilized to assess program impact along seven knowledge and attitudinal dimensions. Survey results revealed that, in comparison to no-treatment groups, the more intensive the program (a) the greater the gains in knowledge about reproductive physiology, contraception, and the consequences of teen pregnancy and parenthood (especially among experimental group females); and (b) the more birth control methods participants became familiar with over time. Changes in personal acceptance of premarital intercourse and perceived responsibility for contraception were observed only in the study examining the most intensive treatment. The results of the evaluations point to the combined importance of instructional methods, teacher quality, and in-class exposure time for producing change in young adolescents' knowledge of and attitudes toward sexuality. Further potential for the impact of school-based sex education programs on knowledge and attitudes is discussed within the broader context of the young adolescent's social environment.