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Niemann J, Wicherski L, Glaum L, Schenk L, Stadler G, Richter M. YouTube and the implementation and discontinuation of the oral contraceptive pill: A mixed-method content analysis. PLoS One 2024; 19:e0302316. [PMID: 38787833 PMCID: PMC11125465 DOI: 10.1371/journal.pone.0302316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/01/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Women living in high-quality healthcare systems are more likely to use oral contraceptives at some point in their lives. Research findings have sparked controversial discussions about contraception in the scientific community and the media, potentially leading to higher rates of method discontinuation. Understanding the underlying motives for method discontinuation is crucial for reproductive health equity and future programming interventions. To address this question, this study aims to explore women's experiences of oral contraceptive use and discontinuation on YouTube. METHODS A concurrent explanatory mixed-methods design was used to conduct content analysis of German YouTube videos. The information from 175 videos of 158 individuals was extracted through quantitative descriptive content analysis. Twenty-one individuals were included in the qualitative content analysis. FINDINGS The body was a recurring theme in the pill biographies. Women described, for example, bodily sensations as reasons for taking and stopping the pill. They also described positive and negative side effects while taking the pill and after stopping. The most common side effects of taking the pill mentioned by YouTubers were mood swings (76/158), weight gain (45/158), headaches (33/158), and depressed mood (45/158). The symptoms after discontinuation reported most were facial skin impurities (108/158), decreased mood swings (47/158), hair loss (42/158), and weight loss (36/158). Overall, women overwhelmingly rated their discontinuation experience as positive (87/91). CONCLUSIONS The study identified key symptoms of oral contraceptive initiation and discontinuation by portraying the experiences of female YouTubers, adding valuable insights to the understanding of method initiation and discontinuation. Further research is needed to explore women's personal experiences with method discontinuation beyond the YouTube platform.
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Affiliation(s)
- Jana Niemann
- Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, Berlin, Berlin, Germany
- Medical Faculty, Institute of Medical Sociology, Institute of Medical Sociology (IMS), Martin Luther University Halle Wittenberg, Interdisciplinary Centre for Health Sciences, Halle (Saale), Saxony-Anhalt, Germany
| | - Lea Wicherski
- Osnabrück University, School of Human Sciences, Osnabrück, Lower Saxony, Germany
| | - Lisa Glaum
- Medical Faculty, Institute of Medical Sociology, Institute of Medical Sociology (IMS), Martin Luther University Halle Wittenberg, Interdisciplinary Centre for Health Sciences, Halle (Saale), Saxony-Anhalt, Germany
| | - Liane Schenk
- Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, Berlin, Berlin, Germany
| | - Getraud Stadler
- Institute for Gender Research in Medicine (GiM), Charité Universitätsmedizin Berlin, Berlin, Berlin, Germany
| | - Matthias Richter
- Medical Faculty, Institute of Medical Sociology, Institute of Medical Sociology (IMS), Martin Luther University Halle Wittenberg, Interdisciplinary Centre for Health Sciences, Halle (Saale), Saxony-Anhalt, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Bavaria, Germany
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Mazza D, Assifi AR, Hussainy SY, Bateson D, Johnston S, Tomnay J, Kasza J, Church J, Grzeskowiak LE, Nissen L, Cameron ST. Expanding community pharmacists' scope of practice in relation to contraceptive counselling and referral: a protocol for a pragmatic, stepped-wedge, cluster randomised trial (ALLIANCE). BMJ Open 2023; 13:e073154. [PMID: 37652588 PMCID: PMC10476139 DOI: 10.1136/bmjopen-2023-073154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Improving access to effective contraception has the potential to reduce unintended pregnancy and abortion rates. Community pharmacists could play an expanded role in contraceptive counselling and referral to contraceptive prescribers particularly when women are already attending community pharmacy to obtain emergency contraceptive pills (ECPs) or to have medical abortion (MA) medicines dispensed. The ALLIANCE trial aims to compare the subsequent uptake of effective contraception (hormonal or intrauterine) in women seeking ECP or MA medicines, who receive the ALLIANCE community pharmacy-based intervention with those who do not receive the intervention. METHODS AND ANALYSIS ALLIANCE is a stepped-wedge pragmatic cluster randomised trial in Australian community pharmacies. The ALLIANCE intervention involves community pharmacists delivering structured, patient-centred, effectiveness-based contraceptive counselling (and a referral to a contraceptive prescriber where appropriate) to women seeking either ECPs or to have MA medicines dispensed. Women participants will be recruited by participating pharmacists. A total of 37 pharmacies and 1554 participants will be recruited. Pharmacies commence in the control phase and are randomised to transition to the intervention phase at different time points (steps). The primary outcome is the self-reported use of effective contraception at 4 months; secondary outcomes include use of effective contraception and the rate of pregnancies or induced abortions at 12 months. A process and economic evaluation of the trial will also be undertaken. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Monash University Human Research Ethics Committee (#34563). An explanatory statement will be provided and written consent will be obtained from all participants (pharmacy owner, pharmacist and women) before their commencement in the trial. Dissemination will occur through a knowledge exchange workshop, peer-reviewed journal publications, presentations, social media and conferences. TRIAL REGISTRATION NUMBER ACTRN12622001024730.
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Affiliation(s)
- Danielle Mazza
- SPHERE NHMRC Centre of Research Excellence, Department General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anisa Rojanapenkul Assifi
- SPHERE NHMRC Centre of Research Excellence, Department General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Safeera Yasmeen Hussainy
- SPHERE NHMRC Centre of Research Excellence, Department General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Deborah Bateson
- The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Jane Tomnay
- Centre for Excellence in Rural Sexual Health, University of Melbourne, Shepparton, Victoria, Australia
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jody Church
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Luke E Grzeskowiak
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
| | - Lisa Nissen
- Centre for the Business & Economics of Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Sharon Tracey Cameron
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
- Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
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Stevenson TB, Rumbold A, Callander E, Buckingham P, Assifi A, Mazza D, Grzeskowiak LE. Online platforms for prescription and supply of hormonal contraception in Australia: a mapping review. Sex Health 2023; 20:273-281. [PMID: 37012210 DOI: 10.1071/sh22138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/13/2023] [Indexed: 04/05/2023]
Abstract
Online platforms have emerged as a convenient way for individuals to access contraception. However, the extent to which such services exist in Australia and how they operate is currently unknown. We aimed to identify Australian online contraception platforms and evaluate the services they provide to determine the degree to which they may facilitate equitable access to contraception. We conducted an internet search to identify online contraception platforms operating in Australia. Data were extracted from each of the platforms relating to operating policies, services provided and associated payment processes, as well as prescribing and screening processes for assessing user suitability. As of July 2022, eight online contraception platforms operating within Australia were identified. All platforms offered oral contraception, with two also offering the vaginal ring, and one emergency oral contraception. None of the platforms provided access to long-acting reversible contraception. Significant variability existed in product and membership costs across platforms, with only one platform providing access to subsidised medicines. Five platforms restricted services to those already using oral contraception. Overall, online questionnaires were deemed to be adequately screening for important contraindications to using oral contraception. While online contraception platforms may be a valuable option for some individuals who face access barriers and are willing to pay out-of-pocket for to have their contraception sent straight to their home, they do not necessarily ensure that individuals can access their contraceptive method of choice or address recognised financial and structural barriers to contraceptive care.
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Affiliation(s)
- Tahlee B Stevenson
- Faculty of Health and Medical Sciences, School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Alice Rumbold
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; and Adelaide Medical School and the Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia; and Women's and Babies Division, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Emily Callander
- School of Public Health and Preventative Medicine, Monash University, Clayton, Vic., Australia
| | - Pip Buckingham
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Vic., Australia
| | - Anisa Assifi
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Vic., Australia
| | - Danielle Mazza
- SPHERE CRE, Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Vic., Australia
| | - Luke E Grzeskowiak
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; and Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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4
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Gerhardt CR, Pulz GTC, Satler F, Leitão CB. Contraception in women with diabetes: adequacy of medical files registration and prescription - a cross-section study. Endocrine 2023; 80:511-519. [PMID: 36914829 PMCID: PMC10010636 DOI: 10.1007/s12020-023-03344-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/26/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To describe the adequacy of diabetes mellitus (DM) patient's files registry regarding contraception method (CM), factors associated with lack of registry, and if prescription is in accordance with World Health Organization (WHO) eligibility criteria. RESEARCH DESIGN AND METHODS This cross-sectional study was developed in two phases: (1) electronic medical records of women with DM who attended the outpatient clinic of a university hospital were reviewed to identify women in reproductive age and to look for CM registration and (2) interviews regarding contraception use, comorbidities and chronic DM complications. RESULTS Among 1069 files analyzed, 313 women with DM in childbearing age were identified. Out of those, 55.3% had a CM registered. Age >40 years, non-white skin color, and ≤11 years of education were associated with no registration. Of the 270 women interviewed, 201 (74.4%) were using CM. Out of the 69 patients not on CM, 51 fertile patients were at risk of an unplanned pregnancy (18.8% of the sample). The most frequently used method was oral hormonal (combined: 34.3%; progestin-only: 17.9%), and 67 (33.3%) were using an inadequate method (WHO eligibility category 3/4). CONCLUSION One third of women with DM are in childbearing age. Older age, non-white skin color, and lower education level were associated with lack of CM registration. One-third of respondents were using CM inappropriate for their clinical condition and one-fifth were at risk for an unplanned pregnancy. So, improvements in family planning for women with DM should be instituted.
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Affiliation(s)
- Caroline R Gerhardt
- Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
- Universidade do Vale do Taquari (UNIVATES), Lajeado, Brazil.
| | - Geórgia T C Pulz
- Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Fabíola Satler
- Endocrine Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Cristiane B Leitão
- Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Endocrine Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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5
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Harris ML, Feyissa TR, Bowden NA, Gemzell-Danielsson K, Loxton D. Contraceptive use and contraceptive counselling interventions for women of reproductive age with cancer: a systematic review and meta-analysis. BMC Med 2022; 20:489. [PMID: 36528586 PMCID: PMC9759910 DOI: 10.1186/s12916-022-02690-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A lack of clarity exists regarding contraceptive uptake and counselling among women with cancer, despite these women having unique family planning needs. This study aimed to systematically review the available literature and produce an overall summary estimate of contraceptive use and counselling among women with cancer across the cancer care continuum. METHODS A systematic search of articles reporting on contraceptive counselling and/or contraceptive use among women of reproductive age (15-49 years) with cancer across the cancer care continuum (e.g. diagnosis, treatment, survivorship) was conducted in MEDLINE, Embase, CINAHL, Maternity and Infant Care and Cochrane Library. Two independent reviewers conducted the data screening, data extraction and risk of bias assessment. Qualitative synthesis and meta-analyses were conducted to summarise the key findings. RESULTS We included 21 articles involving 3835 participants in this review. Studies varied according to the cancer population and time along the cancer care continuum it was assessed. Of the studies that reported the overall contraceptive prevalence among women diagnosed with cancer (n = 8), contraceptive use ranged from 25 to 92%. Of the four studies that focused on cancer survivors, the contraceptive prevalence ranged from 47 to 84%. When the prevalence of these studies was pooled, a crude summary prevalence of 64% (62% among women with cancer versus 68% among cancer survivors) was found. The rate of contraceptive counselling was assessed in ten studies. A pooled prevalence of 50% (44% among women with cancer versus 58% among cancer survivors) was found, with the prevalence ranging from 12 to 78% among individual studies depending on the point in the cancer care continuum that it was provided. When contraceptive counselling was provided, it was found to significantly increase contraceptive use although biases were identified in its application. CONCLUSIONS Contraceptive counselling interventions as part of standard cancer care have the potential to not only empower women with cancer and cancer survivors to make informed choices regarding their reproductive health but also provide the ability to plan future pregnancies for times of better health.
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Affiliation(s)
- Melissa L Harris
- Centre for Women's Health Research, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia. .,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
| | - Tesfaye R Feyissa
- Centre for Women's Health Research, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
| | - Nikola A Bowden
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Centre for Drug Repurposing and Medicines Research, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Deborah Loxton
- Centre for Women's Health Research, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Mazza D, Botfield JR. Opportunities for Increasing Access to Effective Contraception in Australia. Semin Reprod Med 2022; 40:240-245. [PMID: 36478566 DOI: 10.1055/s-0042-1759554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Effective contraception can prevent unintended pregnancies, however there is an unmet need for effective contraception in Australia. Despite their being a range of contraceptive methods available, access to these remains equitable and uptake of the most effective methods is low. There is an opportunity to reduce the rate of unintended pregnancies in Australia by improving the uptake of effective contraception for those who desire this. Improving access will require increasing consumer health literacy about contraception, as well as the option of telehealth as a mode of service delivery, and stronger investment in contraceptive services through appropriate reimbursement for providers. There is also a need to test new models of care to increase access to and use of effective contraception in Australia, including nurse and midwifery-led models of contraceptive care and pharmacy involvement in contraceptive counseling.
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Affiliation(s)
- Danielle Mazza
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Jessica R Botfield
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Melbourne, Victoria, Australia
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7
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Yi KW, Kim SK, Lee DY, Lee SR, Shin H, Choi D. Perceptions and Knowledge of Women Regarding Contraception and Current Trends in Contraceptive Use in Korea. Yonsei Med J 2022; 63:999-1006. [PMID: 36303308 PMCID: PMC9629901 DOI: 10.3349/ymj.2022.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/26/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE This study aimed to investigate the perceptions and behaviors of Korean women of reproductive age in regards to contraception counseling. MATERIALS AND METHODS The study sample was collected in Korea and comprised 1011 women aged 20-44 years and 150 obstetrics and gynecology (OB/GYN) doctors. Participants completed online questionnaires assessing their current methods of contraception, knowledge of and satisfaction with contraceptive methods, and willingness to learn about and use other contraceptive methods. RESULTS Women used condoms (74.2%), natural methods (cycle control or withdrawal, 52.4%), and combined oral contraceptives (COCs) (36.9%) more frequently than long-acting reversible contraception (LARC) methods, such as hormone-releasing intrauterine system (IUS) (4.5%), copper-intrauterine devices (3.3%), and subdermal implants (1.4%). Although the proportion of women who used LARC was low, those who used hormone-releasing IUS or subdermal implants reported high levels of satisfaction. The findings revealed discordant results between women and OB/GYN doctors regarding the initiation and quality of information provided by doctors about contraception and overall satisfaction with counseling. Most women (83.1%) expressed a desire to have more information about various contraceptive methods. More than 60% of women reported a willingness to use LARC, such as hormone-releasing IUS or subdermal implants, when provided with detailed information in counseling. CONCLUSION The majority of Korean women are familiar with condoms and natural methods, but lack knowledge about alternative contraceptive methods, including LARC. Women who used LARC reported higher levels of satisfaction than those who used other methods.
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Affiliation(s)
- Kyong Wook Yi
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sa Ra Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyosun Shin
- Medical Affairs Women's Healthcare, Bayer Korea Ltd. Pharmaceutical, Seoul, Korea
| | - DooSeok Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Mazza D, Buckingham P, McCarthy E, Enticott J. Can an online educational video broaden young women's contraceptive choice? Outcomes of the PREFER pre-post intervention study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:267-274. [PMID: 35228303 DOI: 10.1136/bmjsrh-2021-201301] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/05/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Contraceptive knowledge mediates access and use. We aimed to assess whether an online educational video describing all methods and their benefits, side effects and mode of action increased young women's contraceptive knowledge and their long-acting reversible contraception (LARC) preference and uptake. METHOD We used Facebook advertising to recruit young women aged 16-25 years. Participants completed the pre-video survey (S1), watched the 11-min video, then completed surveys immediately after (S2) and 6 months later (S3). Outcomes were analysed using McNemar tests and multivariate logistic regression (generalised estimating equations). RESULTS A total of 322 participants watched the video, completed S1 and S2, and 88% of those completed S3. At S1 only 6% rated their knowledge about every method as high. Knowledge improved at S2 for all methods (OR 10.0, 95% CI 5.9 to 17.1) and LARC (OR 4.2, 95% CI 3.1 to 5.7). LARC preference increased at S2 (OR 1.7, 95% CI 1.4 to 2.1) and S3 (OR 1.4, 95% CI 1.2 to 1.7), as did LARC uptake at S3 (OR 1.3, 95% CI 1.11 to 1.5). LARC uptake was driven by a 4.3% (n=12) absolute increase in intrauterine device (IUD) use, but there was no change in contraceptive implant use (p=0.8). The use of non-prescription methods such as condoms and withdrawal did not change (OR 0.92, 95% CI 0.76 to 1.11). CONCLUSIONS Many young women in Australia do not feel well informed about their contraceptive options. The contraceptive education video, delivered via social media, increased their self-reported contraceptive knowledge and IUD preference immediately after viewing, and their IUD uptake 6 months later. Focus should be given to how young women navigate contraceptive access after internet-based education, and strategies to increase access to preferred methods.
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Affiliation(s)
- Danielle Mazza
- Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Pip Buckingham
- Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Edwina McCarthy
- Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Joanne Enticott
- Department of General Practice, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
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Niemann J, Schenk L, Stadler G, Richter M. What happens when you stop using the combined contraceptive pill? A qualitative study protocol on consequences and supply needs for women who discontinued the combined contraceptive pill in Germany. BMJ Open 2022; 12:e057089. [PMID: 35760546 PMCID: PMC9237896 DOI: 10.1136/bmjopen-2021-057089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION For more than 60 years, contraceptive pills have been prescribed to mostly healthy biological women. An emerging body of research concerning the possible physiological and psychological side effects of hormonal contraception has been published over the past two decades. Consequently, discontinuing combined oral contraceptives (COCs) as a conscious decision for reasons other than desired pregnancy has become increasingly common for menstruating individuals. The question remains as to what physical and psychological consequences can be observed after discontinuing COCs. In addition, the consequent healthcare needs and situations of affected individuals in Germany have not been explored. This study aims to gain greater insight into the relationship between discontinuation of COCs and (1) possible health consequences, and (2) to explore the supply situation for affected women within the German healthcare system. METHODS AND ANALYSIS Qualitative episodic interviews with women who discontinue COC therapy will explore possible health consequences, and their current healthcare needs and situations in Germany. The interviews will be transcribed verbatim, coded, and in-depth thematic interpretation will be conducted. Subsequently, expert interviews with health professionals who work with women who discontinue COCs will also be conducted. The expert interviews will be analysed according to the documentary method. Overarching themes will represent the perspectives of women and health professionals on the discontinuation of COCs. ETHICS AND DISSEMINATION Ethical approval for this study has been granted by the Ethics Review Committee of Martin Luther University, Halle-Wittenberg (Germany), reference number 2021-34. The findings will be disseminated via peer-reviewed publications, posting via social media and presentations at conferences. This study is registered on the OSF platform under the following number: https://doi.org/10.17605/OSF.IO/JYWXM.
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Affiliation(s)
- Jana Niemann
- Institute of Medical Sociology, Martin Luther University Halle Wittenberg, Halle, Sachsen-Anhalt, Germany
- Institute of Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Liane Schenk
- Institute of Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gertraud Stadler
- Institute for Gender Research in Medicine (GiM), Charité Universitätsmedizin Berlin, Berlin, Germany
- University of Aberdeen, Aberdeen, UK
| | - Matthias Richter
- Institute of Medical Sociology, Martin Luther University Halle Wittenberg, Halle, Sachsen-Anhalt, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munchen, Bayern, Germany
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10
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Taft A, Watson CJ, McCarthy E, Black KI, Lucke J, McGeechan K, Haas M, McNamee K, Peipert JF, Mazza D. Sustainable and effective methods to increase long-acting reversible contraception uptake from the ACCORd general practice trial. Aust N Z J Public Health 2022; 46:540-544. [PMID: 35557481 DOI: 10.1111/1753-6405.13242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/01/2021] [Accepted: 02/01/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Most Australian women access contraception through general practitioners (GPs) but choose oral methods rather than long-acting reversible contraceptives (LARCS). The Australian Contraceptive ChOice pRoject (ACCORd) successfully tested a complex intervention for LARC uptake. We aimed to explore the critical elements of this intervention to increase LARC uptake. DESIGN ACCORd was a cluster randomised control trial conducted in 57 GP clinics in Melbourne, Australia. To explore intervention impact, fidelity checks (n=21 GPs) and interviews with 37 GPs and 40 patients were undertaken 12 months after initial consultations. Data were inductively coded, thematically analysed and mapped to Normalization Process Theory constructs. RESULTS Doctors understood the importance of effectiveness-based contraceptive counselling (EBCC). GPs demonstrated cognitive engagement in the promotion of LARC and some appreciated the rapid referral pathways. GPs and women valued the effectiveness approach. GPs held varying views about having a rapid referral pathway, with many already having established pathways in place. Some GPs viewed intrauterine device insertion costs or insertion training as barriers to ongoing practice. Most GPs and women saw the ACCORD model as effective and sustainable. CONCLUSIONS GP training in EBCC and the use of rapid referral pathways were critical features of an effective sustainable model for successful uptake of LARCs in primary care. IMPLICATIONS FOR PUBLIC HEALTH Improving Australian women's access to and use of LARCs is sustainable with EBCC training and support for general practitioners.
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Affiliation(s)
- Angela Taft
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Victoria
| | - Cathy J Watson
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Victoria
| | - Edwina McCarthy
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Victoria
| | - Kirsten I Black
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, New South Wales
| | - Jayne Lucke
- School of Psychology and Public Health, La Trobe University, Victoria
| | - Kevin McGeechan
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, New South Wales
| | - Marion Haas
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, New South Wales
| | | | - Jeffrey F Peipert
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, USA
| | - Danielle Mazza
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Victoria
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11
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FSFI score and timing of tubal ligation in patients: preliminary results of an online survey. Arch Gynecol Obstet 2022; 306:795-800. [PMID: 35397718 PMCID: PMC9411076 DOI: 10.1007/s00404-022-06547-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/21/2022] [Indexed: 11/02/2022]
Abstract
Abstract
Introduction
Tubal ligation is the most common contraceptive method worldwide. Apart from a very low pearl index and anxiety relief, other benefits are not commonly recognised. In young patients, there is the post-operative risk of regretting the decision with the need for In-Vitro-Fertilisation or refertilising surgery. Positive side effects have not been widely published. In our study we investigated the change in the female sexual function index score after tubal ligation.
Material and method
In this survey the FSFI score of participants around the time of the tubal ligation was compared with the FSFI score of intermediate and long-term time distance to the ligation.
Results
The data indicate an increase in younger women seeking information on permanent contraception and whilst the FSFI score of the early group indicates a risk of female sexual dysfunction, the intermediate and long-term FSFI scores are comparable to published control groups.
Discussion
Besides the obvious benefit of a low pearl index, tubal ligation may contribute to reduce the risk of female sexual dysfunction in the mid and long term. Informed consent is essential for the surgeon and patient to weigh up the risks and benefits individually including possible future perspectives on family planning.
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12
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Garrett CC, Vaisey A. 'Most women really actually do just appreciate being asked': clinicians' views on integrating sexual wellbeing into contraceptive care. CULTURE, HEALTH & SEXUALITY 2022; 24:315-329. [PMID: 33170110 DOI: 10.1080/13691058.2020.1840630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
A growing body of literature suggests that contraceptives' impact on sexual experiences influences willingness to initiate and continue with a method. Little is known, however, about how clinicians engage with clients on this topic during contraceptive consultations. Fifteen clinicians in South Eastern Australia participated in semi-structured interviews between April and June 2019. Interviews were analysed using inductive, semantic thematic analysis. Participants varied in their evaluation and management of contraceptives' sexual side effects and the legitimacy given to women's bodily experience versus their own understanding of the evidence in the medical literature. We identified two distinct groups of clinicians: those who prioritised sexual wellbeing as a primary issue in contraceptive consultations and those who perceived sexual wellbeing as a secondary concern. The difference in practices was influenced by whether participants considered sexual wellbeing to be part of holistic care provision and their views on the clinician's role in raising the topic. Strategies to equip clinicians to integrate sexual wellbeing into contraceptive consultations include interactive clinical training and incorporating information about sexual side effects into contraceptive guidelines and client resources. Benefits gained from normalising sexual wellbeing could extend beyond contraceptive care to help clinicians address clients' sexual wellbeing in other contexts.
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Affiliation(s)
| | - Alaina Vaisey
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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13
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Danna K, Angel A, Kuznicki J, Lemoine L, Lerma K, Kalamar A. Leveraging the Client-Provider Interaction to Address Contraceptive Discontinuation: A Scoping Review of the Evidence That Links Them. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:948-963. [PMID: 34933989 PMCID: PMC8691884 DOI: 10.9745/ghsp-d-21-00235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/06/2021] [Indexed: 11/26/2022]
Abstract
Despite considerable investment and effort, unmet need for contraception remains an obstacle to improved family planning outcomes. One influencing factor is the frequency of contraceptive discontinuation among users who desire to prevent pregnancy, often due to method-related concerns and side effects. Contraceptive users have the right to be supported during counseling to voluntarily choose methods that align with their individual needs and preferences. Contraceptive counseling, as a key component of quality of care, is particularly important for providers to reduce unmet need among their clients. This scoping review examined the state of the evidence on contraceptive counseling and its impact on discontinuation. The review first examines the association between quality of care and contraceptive discontinuation, then looks to what the current body of evidence suggests are women's contraceptive counseling priorities, and lastly, explores whether specific counseling tools and approaches have been evaluated with discontinuation as an outcome. The results identified general principles and priorities for good counseling including person-centeredness, client-tailored information exchange, clear and concise information on side effects and bleeding changes, reducing providers' implicit and explicit biases, and trust and respect between the client and provider. The review of the literature also found that evidence to support the use of specific counseling tools and approaches to reduce contraceptive discontinuation is insufficient; research should be designed to determine which specific elements of the client-provider interaction can be improved to significantly impact contraceptive discontinuation. This evidence could inform how the global community of practice might improve and leverage specific counseling approaches and tools to address the most common predictors of discontinuation.
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Affiliation(s)
- Kendal Danna
- Population Services International, Washington, DC, USA.
| | | | | | | | - Klaira Lerma
- Stanford University, Stanford, CA, USA
- University of Texas at Austin, Austin, TX, USA
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14
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Ding J, Williams H, Hocking JS, Coombe J. Requesting early removal of long-acting reversible contraception: a qualitative study exploring the experiences of doctors working in primary care. Aust J Prim Health 2021; 27:467-472. [PMID: 34794545 DOI: 10.1071/py21054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022]
Abstract
Long-acting reversible contraceptives (LARC) are the most effective contraceptive methods available in Australia and are effective for between 3 and 8 years. Early LARC removal (<12 months of use) can lead to gaps in contraceptive cover, exposing women to the risk of unplanned pregnancy. This study explored the experiences of doctors working in primary care (GPs and sexual health physicians) when asked to remove LARC earlier than expected. From May to July 2020, 13 doctors in Melbourne, Australia, were interviewed. Overall, participants felt conflicted about early LARC removal requests; participants highlighted the importance of respecting patient autonomy, but many felt that patients should ideally persist with LARC longer. Participants found balancing a desire to respect patients' autonomy with their clinical responsibility challenging. Doctors used reassurance, delaying tactics and treatment of side effects to try and prolong LARC use. However, this balancing act led many doctors to perceive a tension between themselves and their patients when early LARC removal was requested. Incorporating professional education addressing these issues may help primary care providers better anticipate and navigate the tension surrounding early LARC removal consultations and maintain effective doctor-patient relationships.
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Affiliation(s)
- Jacqueline Ding
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, L3, 207 Bouverie Street, Parkville, Vic. 3010, Australia; and Corresponding author.
| | - Henrietta Williams
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, L3, 207 Bouverie Street, Parkville, Vic. 3010, Australia; and Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, L3, 207 Bouverie Street, Parkville, Vic. 3010, Australia
| | - Jacqueline Coombe
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, L3, 207 Bouverie Street, Parkville, Vic. 3010, Australia
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15
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Stern J, Molin MS, Fernaeus M, Georgsson S, Carlsson T. Contraceptive counseling about adverse reactions of intrauterine contraception: Exploration of narratives found in web-based discussion boards. Midwifery 2021; 104:103166. [PMID: 34717242 DOI: 10.1016/j.midw.2021.103166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/17/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE the possibility of experiencing adverse reactions is an important aspect of contraceptive decision-making and information about this topic is highlighted as an essential aspect of contraceptive counseling. The aim of this study was to explore experiences of contraceptive counseling about potential adverse reactions of intrauterine contraception. DESIGN exploratory qualitative study of messages in discussion boards, analyzed with inductive qualitative content analysis. SETTING two large public Swedish web-based discussion boards about sexual and reproductive health. PARTICIPANTS threads related to the aim were identified through searches in the discussion boards during 2019 and 2020, resulting in in 43 included posters who had written 140 messages in total. FINDINGS the themes 'difficulties making an informed decision due to insufficient and untrustworthy information about adverse reactions' and 'feeling dismissed when communicating about experienced adverse reactions' illustrate the results. Posters emphasized the importance of sufficient information about adverse reactions. However, professionals were perceived as overly optimistic regarding intrauterine contraception and focusing on mild or common reactions. The importance of feeling that their adverse reactions were acknowledged was articulated, but posters felt that some professionals dismissed the reactions when being told about it, resulting in frustration and dissatisfaction with care. The discussion boards contained narratives describing a resistance among professionals to send in a formal report about the adverse reaction. KEY CONCLUSIONS according to statements made by posters who have experience of adverse reactions of intrauterine contraception, contraceptive counseling have room for improvement in regard to inclusion of comprehensive information about adverse reactions. The findings illustrate the importance that clients who experience adverse reactions of intrauterine contraception feel they are acknowledged and offered adequate support. IMPLICATIONS FOR PRACTICE echoing guidelines for high-quality contraceptive counseling, the narratives provide further weight that professionals need to have adequate training and resources to offer comprehensive information about adverse reactions of intrauterine contraception. The findings call attention to the importance of follow-up services for clients who experience adverse reactions.
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Affiliation(s)
- Jenny Stern
- Sophiahemmet University, Box 5605, SE-114 86, Stockholm, Sweden; Department of Women's and Children's Health, MTC-huset, Dag Hammarskjölds väg 14B, SE-75237, Uppsala university, Uppsala, Sweden
| | | | - Maja Fernaeus
- Sophiahemmet University, Box 5605, SE-114 86, Stockholm, Sweden
| | - Susanne Georgsson
- The Swedish Red Cross University College, Box 1059, SE 141 21 Huddinge, Sweden; Karolinska Institutet, Department of Clinical science, Intervention and technology, SE-171 77 Stockholm, Sweden
| | - Tommy Carlsson
- Department of Women's and Children's Health, MTC-huset, Dag Hammarskjölds väg 14B, SE-75237, Uppsala university, Uppsala, Sweden; The Swedish Red Cross University College, Box 1059, SE 141 21 Huddinge, Sweden.
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16
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Harris ML, Egan N, Forder PM, Coombe J, Loxton D. Contraceptive use among women through their later reproductive years: Findings from an Australian prospective cohort study. PLoS One 2021; 16:e0255913. [PMID: 34379661 PMCID: PMC8357106 DOI: 10.1371/journal.pone.0255913] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Examine patterns of contraceptive use and contraceptive transitions over time among an Australian cohort of women through their later reproductive years. Study design Latent Transition Analysis was performed using data on 8,197 women from the Australian Longitudinal Study on Women’s Health’s 1973–78 cohort to identify distinct patterns of contraceptive use across 2006, 2012 and 2018. Women were excluded from the analysis at time points where they were not at risk of an unintended pregnancy. Latent status membership probabilities, item-response probabilities, transitions probabilities and the effect of predictors on latent status membership were estimated and reported. Results Patterns of contraceptive use were relatively consistent over time, particularly for high efficacy contraceptive methods with 71% of women using long-acting reversible contraceptives in 2012 also using long-acting reversible contraceptives in 2018. Multiple contraceptive use was highest in 2006 when women were aged 28–33 years (19.3%) but declined over time to 14.3% in 2018 when women were aged 40–45 years. Overall, contraceptive patterns stabilised as the women moved into their late 30s and early 40s. Conclusions Although fertility declines with age, the stability of contraceptive choice and continued use of short-acting contraception among some women suggests that a contraceptive review may be helpful for women during perimenopause so that they are provided with contraceptive options most appropriate to their specific circumstances.
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Affiliation(s)
- Melissa L. Harris
- Centre for Women’s Health Research, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- * E-mail:
| | - Nicholas Egan
- Centre for Women’s Health Research, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Peta M. Forder
- Centre for Women’s Health Research, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Deborah Loxton
- Centre for Women’s Health Research, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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17
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Morison T. Reproductive justice: A radical framework for researching sexual and reproductive issues in psychology. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2021. [DOI: 10.1111/spc3.12605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Tracy Morison
- School of Psychology Massey University Palmerston North Manawatu New Zealand
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18
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Garga S, Thomas M, Bhatia A, Sullivan A, John-Leader F, Pit S. Geosocial Networking Dating App Usage and Risky Sexual Behavior in Young Adults Attending a Music Festival: Cross-sectional Questionnaire Study. J Med Internet Res 2021; 23:e21082. [PMID: 33856354 PMCID: PMC8085743 DOI: 10.2196/21082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/02/2020] [Accepted: 02/25/2021] [Indexed: 12/26/2022] Open
Abstract
Background Despite the prevalent use of geosocial networking dating apps (GNDAs), there is limited research on their impact on sexual health outcomes among young music festivals attendees. Objective This study aims to explore the use of GNDAs and risky sexual behaviors of young adults attending a music festival. Methods The music festival attendees (N=862) completed a cross-sectional questionnaire study encompassing demographics, dating app use, and risky sexual behaviors in the past year. Associations between these variables were estimated using bivariate and multivariate logistic regression analyses. Results Of the respondents, 51.9% (448/862) had used GNDAs in the previous year. Compared with people who had 1 partner, people who had 2-5 sexual partners in the previous year had almost 7 times the odds of using dating apps (odds ratio [OR] 6.581, 95% CI 4.643-9.328) and those who had more than 5 partners had 14 times the odds of using dating apps (OR 14.294, 95% CI 8.92-22.906). Condom users were more likely to be app users (P<.001), as were those who relied on emergency Plan B (P=.002), but people using hormonal contraception were less likely to use dating apps (P=.004). After adjusting for sexual orientation and relationship status, those having casual sex had 3.096 (95% CI 2.225-4.307; P<.001) times the odds of using dating apps and those having multiple sexual partners had 3.943 (95% CI 2.782-5.588; P<.001) times the odds of using dating apps. Similarly, after adjusting for sexual orientation, relationship status, and number of sexual partners, people who had no discussions before having sex about sexually transmitted infections (STIs) or boundaries were more likely to use dating apps (OR 1.755, 95% CI 1.232-2.500; P=.002). Those who perceived the risk of having sex without contraception to be very high had 2.486 (95% CI 2.213-5.096; P=.01) times the odds of using dating apps than those who perceived no risk. Compared with those who perceived no risk, people who thought that the risk of having multiple sexual partners was low to high had 1.871 (95% CI 1.024-3.418; P=.04) times the odds of using dating apps. A significant number of app users (389/440, 88.4%) indicated that GNDAs should promote safe sex. Conclusions This study identified that festival goers engaging in certain high-risk sexual behaviors, including casual sex, having multiple sexual partners, and having sex without discussion about STI status and boundaries, are more likely to use dating apps. Festival goers who perceived sex without any form of contraception, having sex while drunk, and having multiple sexual partners as risky were more likely to be app users. Policy makers and GNDA developers should acknowledge the vulnerability of their users to adverse sexual health outcomes and use GNDAs as a platform to promote risk-reduction practices.
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Affiliation(s)
- Shirali Garga
- University Centre for Rural Health, Western Sydney University, Lismore, Australia
| | - Meryl Thomas
- University Centre for Rural Health, Western Sydney University, Lismore, Australia
| | - Ashneet Bhatia
- University Centre for Rural Health, Western Sydney University, Lismore, Australia
| | - Aidan Sullivan
- University Centre for Rural Health, Western Sydney University, Lismore, Australia
| | - Franklin John-Leader
- Harm Reduction and Health Promotion Programs, HIV and Related Programs (HARP), North Coast Public Health, Mid-North Coast Local Health District, Lismore, Australia
| | - Sabrina Pit
- University Centre for Rural Health, Western Sydney University, Lismore, Australia.,University Centre for Rural Health, University of Sydney, Lismore, Australia.,NSW Rural Doctors Network, Newcastle, Australia
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19
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Black KI, McGeechan K, Watson CJ, Lucke J, Taft A, McNamee K, Haas M, Peipert JF, Mazza D. Women's satisfaction with and ongoing use of hormonal long-acting methods compared to the oral contraceptive pill: Findings from an Australian general practice cluster randomised trial (ACCORd). Aust N Z J Obstet Gynaecol 2021; 61:448-453. [PMID: 33599984 DOI: 10.1111/ajo.13319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Australian Contraceptive ChOice pRoject (ACCORd) aimed to assess the impact of a complex general practice intervention on the uptake of long-acting reversible contraceptives (LARC). AIMS Using survey data from enrolled women, we aimed to compare the ongoing use and satisfaction of women who chose one of the hormonal LARC methods including the levonorgestrel intrauterine system (LNG-IUS) or levonorgestrel implant compared to the oral contraceptive pill (OCP). MATERIALS AND METHODS We used the data from participants' baseline, six and 12-month surveys to identify new users of implants, LNG-IUS or OCP. We included demographic information, ongoing use of the contraceptive method, reasons for dissatisfaction and discontinuation and experience of side-effects. Proportions were compared using χ2 tests. RESULTS Of the 740 women enrolled in ACCORd, 176 started using a hormonal LARC or OCP in the study's first six months with 76 using the IUS (43%), 60 the implant (34%) and 40 (23%) the OCP. Twelve-month continuation rates for the LNG-IUS, implant and OCP were 93, 83 and 65% respectively (P < 0.001). Satisfaction was highest among the LNG-IUS users; 86% were very/somewhat satisfied compared to 75% of implant users and 61% of OCP users (P < 0.001). Main reasons for method dissatisfaction were irregular bleeding and mood changes which were similar for all methods. CONCLUSIONS This study provides further evidence that hormonal LARC methods have higher continuation and satisfaction rates compared to the OCP with similar side-effects. Since hormonal LARC methods have the highest contraceptive efficacy, these should be offered first-line to women.
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Affiliation(s)
- Kirsten I Black
- Sydney School of Medicine (Central Clinical School) Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney Local Area Health Service, Sydney, New South Wales, Australia
| | - Kevin McGeechan
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Cathy J Watson
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Jayne Lucke
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Angela Taft
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | | | - Marion Haas
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, New South Wales, Australia
| | - Jeffrey F Peipert
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Danielle Mazza
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
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20
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Lukasse M, Baglo MCG, Engdal E, Lassemo R, Forsberg KE. Norwegian women's experiences and opinions on contraceptive counselling: A systematic textcondensation study. Eur J Midwifery 2021; 5:4. [PMID: 33554056 PMCID: PMC7856575 DOI: 10.18332/ejm/132224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Contraception plays a pivotal role in most women's lives, from teenage years to the menopause. Contraception and sexual wellbeing are closely related. Ideally, women should be able to access contraception and discuss issues concerning their sexual life during a contraceptive counselling session. Previously, only doctors conducted contraceptive consultations. Increasingly, other healthcare workers are providing contraceptive care. The aim of this study is to explore women's experiences and opinions related to contraceptive counselling. METHODS An electronic questionnaire was distributed in 2017-2018. The texts of 308 women's written responses to open-ended questions were analyzed using systematic text-condensation. RESULTS The analysis resulted in four themes: 1) Women-centered care, 2) Side-effects of hormonal contraceptives, 3) Non-hormonal methods and male involvement, and 4) Counsellors' professional background. Women wished for a consultation that would lead to the best choice of contraception for them, taking into account their medical history, personal preference and living circumstances. Side-effects of hormonal products were under-communicated, as were non-hormonal methods. Respondents had contradicting opinions about midwives as contraceptive counsellors and were unfamiliar with them in this role. CONCLUSIONS The quality of contraceptive counselling in Norway needs to be improved. Women require individualized follow-up, sufficient information and a choice of methods to find the most suitable alternative for them. A good relationship with a health provider they trust could improve contraceptive consultation. Midwives' knowledge and competence in this area need to be made more widely known.
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Affiliation(s)
- Mirjam Lukasse
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
| | - Marie Christine G. Baglo
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
- Maternity Unit, Tønsberg Hospital, Tønsberg, Norway
| | - Eldri Engdal
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
- Maternity Unit, Lillehammer Hospital, Innlandet Hospital Trust, Lillehammer, Norway
| | - Ragnhild Lassemo
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
- Maternity Unit, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Kristin E. Forsberg
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
- Community Health Services, Horten, Norway
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21
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Skiba MA, Islam RM, Bell RJ, Davis SR. Hormonal contraceptive use in Australian women: Who is using what? Aust N Z J Obstet Gynaecol 2019; 59:717-724. [PMID: 31250431 DOI: 10.1111/ajo.13021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/15/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND In Australia many hormonal contraceptives are not Pharmaceutical Benefits Scheme (PBS) supported, hence the use of different formulations have not been quantified. OBJECTIVES To document the use of hormonal contraceptives and factors associated with their use. MATERIALS AND METHODS Cross-sectional, online questionnaire-based study of 6986 Australian women, aged 18-39 years, recruited by email invitation from two large, representative databases. Main outcome measures were the prevalence of use of hormonal contraceptives and associated socio-demographic characteristics. RESULTS Of the 6600 potential hormone contraceptive users, 43.2% were current users. Most (63.6%) reported using a combined oral contraceptive (COC) of which 30.9% were non-PBS-supported anti-androgenic progestin-containing COCs. Use of long-acting reversible contraceptives (LARC) or an injectable contraceptive was reported by 26.8%. Education beyond secondary school, being Australian born, rural residency, normal body mass index, age <25 years and nulliparity were significantly associated with hormonal contraceptive use. Women who reported polycystic ovary syndrome or acne were more likely to be taking a third or fourth generation COC (P < 0.0001) and endometriosis was significantly associated with intrauterine system (IUS) use. Third or fourth generation COC use was reported by 12.1% of obese, current smokers. CONCLUSION An estimated one-third of Australian women aged 18-39 are taking a non-PBS-supported anti-androgenic progestin COC, highlighting inequity in access to COC options. That hormonal contraceptive use is higher in rural areas is a novel finding and the proportion of LARC or injectable use suggests that uptake in Australia is higher than previously reported.
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Affiliation(s)
- Marina A Skiba
- Women's Health Research Program, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rakibul M Islam
- Women's Health Research Program, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robin J Bell
- Women's Health Research Program, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susan R Davis
- Women's Health Research Program, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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22
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Abstract
PURPOSE OF REVIEW Quality contraceptive counseling has been identified as a potential means to reduce unintended pregnancy and to increase contraceptive continuation and satisfaction. Past approaches that focused on autonomous decision making and directive counseling have not been shown to meet these goals consistently. Women's health organizations globally are calling for improved counseling through more thorough discussion of side-effects and bleeding changes, and renewed focus on shared decision making and patient-centered care. RECENT FINDINGS Reproductive life planning can help initiate contraceptive counseling but does not resonate with all patients. A client-centered approach using shared decision making, building trust, and eliciting client preferences has been shown to increase satisfaction and continuation. Patient preferences vary widely and may or may not prioritize extremely high effectiveness. Decision support tools have mixed results, but generally can help improve the method choice process when they are well designed. SUMMARY Clinicians should strive for good interpersonal relationships with patients, and elicit patient experiences and preferences to tailor their counseling to each individual's needs. Shared decision making with input from both the patient and clinician is preferred by many women, and clinicians should be cognizant of perceptions of pushing any method too strongly, especially among marginalized populations. More research on long-term satisfaction and continuation linked to different counseling practices is needed.
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23
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Merki-Feld GS, Caetano C, Porz TC, Bitzer J. Are there unmet needs in contraceptive counselling and choice? Findings of the European TANCO Study. EUR J CONTRACEP REPR 2018; 23:183-193. [DOI: 10.1080/13625187.2018.1465546] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- G. S. Merki-Feld
- Department of Reproductive Endocrinology, University Hospital, Zurich, Switzerland
| | | | | | - J. Bitzer
- Department of Obstetrics/Gynecology, University Hospital, Basel, Switzerland
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