Contraceptive counseling and patient experience

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Using a contraceptive counseling protocol provides a means to increase consistency in contraceptive counseling practices across health centers and improve patient satisfaction, according to a study in the journal Contraception.

“We conducted this study to better understand how an evidence-informed contraceptive counseling intervention affected patients’ experiences with counseling and whether they continued to use the methods of choice in the short term,” said principal investigator Hannah Simons, DrPH, senior director of research and evaluation at Planned Parenthood Federation of America.

Methods
A total of 756 patients from 10 randomized Planned Parenthood health centers in Southeastern states were surveyed between December 2016 and June 2017. The intervention group had an initial visit with a staff member who had received 8 hours of in-person training and structural follow-up in 10 evidence-informed practices to support patients’ contraceptive decision-making and use, whereas the control group had typical counseling with a staff member who had not taken the specialized training.

“Planned Parenthood staff are already highly trained and competent in contraceptive counseling, so finding an approach that had measurably better outcomes is particularly noteworthy,” Dr. Simons told Contemporary OB/GYN. 

All patients completed a baseline survey immediately post-visit, followed by a 1-month and 3-month survey for which 77% of patients completed one or both. Over the 3-month period, the study assessed whether patients were more satisfied with their birth control method, the single counseling session and health center when their providers used the evidence-informed Contraceptive Counseling Protocol (CCP) versus standard counseling. The study also examined if patients were more likely to consistently use their birth control method of choice as a result of the CCP. 

Findings
The study revealed that patients who received the contraceptive counseling intervention were significantly more satisfied with their contraceptive method (4.8 vs. 4.6 for the control group, on a scale of 1 to 5), the counselor (4.9 vs. 4.7), counseling session (4.9 vs. 4.6), and health center (4.9 vs. 4.7) immediately after their health center visit (P < 0.0001).

Patients in the intervention group were also more likely to report experiencing all evidence-informed counseling practices: adjusted prevalence ratio (aPR) = 2.27; 95% confidence interval (CI): 1.27 to 4.04, along with more consistency in the way providers counseled them about contraception.

“Additionally, there was no significant difference in the type of contraception that patients ultimately selected,” Dr. Simons said. “Similar proportions of participants selected birth control pills, condoms, intrauterine devices (IUDs), implants and injections across both study groups.”

Likewise, after 3 months, there were no sustained differences in contraceptive behaviors. Participants in both groups reported comparable frequencies of missed oral contraceptive pills in the last cycle among those who selected the pill at baseline (33% in the intervention group vs. 35% in the control group [P = 0.94]) and having gaps of at least 2 weeks in contraceptive protection (75% vs. 86%, respectively [P = 0.08]). 

Conclusions
“With a shorter follow-up, we expected to see a sustained positive change in contraceptive behaviors, including method continuation and accurate use of birth control pills, in the intervention compared to the control group,” Dr. Simons said. “But this did not bear out in our findings, which may point to a need for additional support and follow-up after an initial health center visit.” 

She noted that the study’s contraceptive counseling protocol training is a tool for standardizing contraceptive counseling across geographically dispersed health centers and can be used to enhance patient experiences with care.

“Future counseling interventions might examine whether follow-up telephone calls with counseling staff or the use of online patient-facing resources, texts or apps can supplement the contraceptive counseling patients receive in the health center,” Dr. Simons said. “Patients may also be key partners in developing counseling strategies that are relevant and acceptable.”

Disclosures:

Dr. Simons reports no relevant financial disclosures.