A checklist approach to caring for women seeking pregnancy testing: Effects on contraceptive knowledge and use

Abstract

Objective To assess how a checklist reminding clinicians to deliver a bundled intervention affects contraceptive knowledge and use 3 months after women seek walk-in pregnancy testing. Methods Pre-intervention, an inner-city family planning clinic provided unstructured care; during the intervention period, clinic staff used a checklist to ensure women received needed services. Women seeking walk-in pregnancy testing who wished to avoid pregnancy for at least 6 months were asked to complete surveys about their contraceptive knowledge and use immediately after and 3-months after visiting the study clinic. To assess the significance of changes over time, we used logistic regression models. Results Between January 2011 and May 2013, over 1500 women sought pregnancy testing from the study clinic; 323 completed surveys (95 pre-intervention and 228 during the intervention period). With this checklist intervention, participants were more likely to receive emergency contraception (EC) (22% vs. 5%, aOR=4.64, 95% CI 1.77-12.17), have an intrauterine device or implant placed at the time of their clinic visit (5% vs. 0%, p=0.02), or receive a contraceptive prescription (23% vs. 10%, p<0.001). Three months after visiting the study clinic, participants from the intervention period were more knowledgeable about intrauterine and subdermal contraception and were more likely to be using intrauterine, subdermal or injectable contraception (aOR=2.18, 95% CI 1.09-4.35). Conclusions Women seeking walk-in pregnancy testing appear more likely to receive EC and to have switched to a more effective form of birth control in 3 months following their visit when clinic staff used a 3-item checklist and provided scripted counseling. Implications A checklist reminding clinic staff to assess pregnancy intentions, provide scripted counseling about both emergency and highly-effective reversible contraception, and offer same-day contraceptive initiation to women seeking walk-in pregnancy testing appears to increase use of more effective contraception.

A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: what works and what doesn’t?

“…Four pre-post studies found evidence of increases in contraceptive use after interventions systematising the provision of contraceptive counselling to all women attending non-FP outpatient services, including adolescents in juvenile detention in the USA,73 voluntary counselling and testing (VCT) clients in Ethiopia,74 women seeking pregnancy testing at a walk-in clinic in the USA,75 and women attending an abortion clinic in the UK 76. However, these interventions also included expanded method provision.…”

Young Women's Perspectives About the Contraceptive Counseling Received During Their Emergency Contraception Visit

“…Most women who use EC pills are young adults or adolescents, and have recently had unprotected sex or experienced a method failure (Daniels, Jones, & Abma, 2013). Providers often see the EC visit as an opportunity to encourage women to use or initiate a contraceptive method in addition to EC, and more recently, to increase awareness about the availability of the IUD as EC and as an ongoing method (ACOG, 2015;Falk, Falk, Hanson, & Milsom, 2001;Lee, Papic, Baldauf, Updike, & Schwarz, 2015;Schwarz et al, 2014). Providers may view the EC visit as a chance to offer women these additional counseling services beyond what they would receive through pharmacy provision of EC.…”

Pathways to reproductive autonomy: Using path analysis to predict family planning outcomes in the United States

“…Previous research suggests that health insurance (Kavanaugh et al, 2020 ; Nearns, 2009 ), provider engagement (Dehlendorf et al, 2016 ; Lee et al, 2015 ), and contraceptive knowledge (Frost et al, 2012 ; Guzzo & Hayford, 2018 ) are important predictors of family planning outcomes. This study corroborates these findings and extends previous research by suggesting that these are also important predictors of access to preferred contraception and that access to the preferred contraceptive method may be the mechanism by which these factors impact family planning outcomes.…”

“…Scholars and public health advocates have recommended that healthcare providers assess patients' reproductive life plans and tailor contraceptive decision‐making support based on patients' needs and priorities (Casey & Gomez‐Lobo, 2013 ; Dehlendorf et al, 2014 ; Holt et al, 2017 ). Research shows that when patients experience this sort of provider engagement during contraceptive counselling, they are more likely to initiate or continue contraceptive use and maintain the use of a highly effective method (Dehlendorf et al, 2016 ; Lee et al, 2015 ).…”