Elsevier

Contraception

Volume 88, Issue 2, August 2013, Pages 243-249
Contraception

Original research article
Structured contraceptive counseling provided by the Contraceptive CHOICE Project

https://doi.org/10.1016/j.contraception.2012.07.015Get rights and content

Abstract

Background

We describe the contraceptive counseling provided by the Contraceptive CHOICE Project (CHOICE) and compare contraceptive methods selected between the university research site and community partner clinics.

Study Design

We developed a structured, contraceptive counseling program. All CHOICE participants enrolling at our university research site underwent the counseling, which was evidence-based and included information about all reversible contraception. Participants enrolling at partner clinics underwent “usual” counseling. We trained 54 research team members to provide contraceptive counseling; the majority had no formal health care training. We compared the contraceptive methods chosen by participants enrolling at our university research site to participants enrolling at partner clinics who did not undergo structured contraceptive counseling.

Results

There were 6,530 (86%) women who enrolled into CHOICE at our university site and 1,107 (14%) women who enrolled at partner clinics. Uptake of long-acting reversible contraception was high at both the university site and partner clinics (72% and 78%, respectively, p<.0001). However, uptake of the intrauterine device was higher at the university site (58% compared to 43%, p<.0001) and uptake of the subdermal implant was higher at partner clinics (35% versus 14%, p<.0001). After adjusting for confounders, we found no difference in the uptake of long-acting reversible contraception between women counseled at the university site compared to partner clinics (adjusted relative risk=0.98, 95% confidence interval [0.94, 1.02]).

Conclusion

Structured contraceptive counseling can be effectively provided in a clinical research setting by staff without prior health care experience or clinical training.

Introduction

Contraceptive counseling has the potential to increase the uptake of highly effective methods of contraception, to improve contraceptive use, and to increase continuation and satisfaction. However, prior studies of contraceptive counseling have not demonstrated consistent results. A survey of women after a visit with their primary care providers found that women who received counseling about hormonal contraception were more likely to report use of that method at last intercourse [1]. A recent Cochrane review found that there was no data to support the effectiveness of contraceptive counseling in improving contraceptive adherence [2]. However, in this review, the authors did not evaluate whether contraceptive counseling impacted the choice of contraceptive method. A randomized controlled trial of structured contraceptive counseling among women seeking abortion did not show any increase in the uptake of very effective contraceptive methods compared to typical counseling [3]. A limitation of this study was that the typical counseling was provided by family planning specialists, which may have attenuated the effect of the structured counseling.

Increasing the uptake of highly effective contraceptive methods and improving contraceptive continuation are important strategies to decrease unintended pregnancy. The Contraceptive CHOICE Project (CHOICE) is an ongoing cohort study of 9,256 women with high uptake of long-acting reversible contraception (LARC) which includes the intrauterine device (IUD) and the subdermal implant. In this paper, we provide a description of the structured contraceptive counseling developed as part of CHOICE and compare the uptake of LARC between participants enrolled at the university site where they received structured contraceptive counseling and partner clinics where they received “usual” counseling.

Section snippets

Methods

We have described the methods of CHOICE in detail elsewhere [4], but will briefly review them here. CHOICE is a prospective cohort study of 9,256 women designed to: 1) promote the use of LARC; 2) remove financial barriers to contraception; 3) evaluate continuation and satisfaction for reversible methods; and 4) reduce unintended pregnancies in the St. Louis region. Women were eligible to participate if they were aged 14–45 years, resided in St. Louis City or County, had been sexually active

Results

Since 2007, the CHOICE Project has trained a total of 54 contraceptive counselors. Approximately 70% of the trainees were employed members of the CHOICE research team (n=38). In addition, we also trained 16 volunteers; the majority of these were first- and second-year medical students (n=14). Almost all (96%) of the trained contraceptive counselors had at least an undergraduate degree and 2 had professional health care degrees (RN and NP). Among the CHOICE research staff, 39% (n=15) had no

Discussion

Our experience in the Contraceptive CHOICE Project demonstrates that a structured, comprehensive contraceptive counseling program can be successfully implemented in a high-volume, clinical research setting. Almost half of our contraceptive counselors had no prior clinical experience and 96% did not have a professional health care degree. This bolsters the argument that contraceptive counseling does not have to be performed by an individual with a clinical background. However, it is necessary to

Acknowledgments

This research was supported in part by: 1) an anonymous foundation; and 2) Award number K23HD070979 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NICHD, or NIH.

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