Reproductive Life Planning and Contraceptive Action Planning for Privately Insured Women: The MyNewOptions Study

Abstract

219CONTEXT: Although reproductive life planning (RLP) is recommended in federal and clinical guidelines and may help insured women make personalized contraceptive choices, it has not been systematically evaluated for effectiveness. METHODS:In 2014, some 984 privately insured women aged 18-40 who were not intending to become pregnant in the next year were randomly assigned to receive RLP, RLP with contraceptive action planning (RLP+) or information only (the control group). Women's contraceptive use, prescription contraceptive use, method adherence, switching to a more effective method, method satisfaction and contraceptive self-efficacy were assessed at six-month intervals during the two-year follow-up period. Differences between groups were identified using binomial logistic regression, linear regression and generalized estimating equation models. RESULTS:During the follow-up period, the proportion of women using any contraceptive method increased from 89% to 96%, and the proportion using a long-acting reversible contraceptive or sterilization increased from 8% to 19%. Contraceptive adherence was high (72-76%) in all three groups. In regression models, the sole significant finding was that women in the RLP+ group were more likely than those in the RLP group to use a prescription method (odds ratio, 1.3). No differences were evident between the intervention groups and the control group in overall contraceptive use, contraceptive adherence, switching to a more effective method, method satisfaction or contraceptive self-efficacy. CONCLUSIONS:The study does not provide evidence that web-based RLP influences contraceptive behaviors in insured women outside of the clinical setting. Further research is needed to identify strategies to help women of reproductive age identify contraceptive methods that meet their needs and preferences.

A scoping review of the format, content, effectiveness and acceptability of reproductive life planning tools

“…Studies focused on implementation in a clinical setting often mentioned the importance of taking a patient-centred approach, ensuring shared decision-making and balanced counselling, and aspects of motivational interviewing, which is a recognised behaviour change technique. The web-based ‘My New Options’ RLP incorporated action planning (19). This encourages a person to think in advance how to implement the desired behaviour and how to address challenges, reducing the cognitive load when these situations are faced (73).…”

“…The four studies of digital RLPs’ acceptability (19, 20, 43, 51), found them to be an acceptable format, including in one study that included men (20). Respondents described an interactive, web-based format as easy to use and ‘desirable’ (19) with the majority reporting that they liked the online format (e.g. 75.3% in 43).…”

“…The web-based 'My New Options' RLP incorporated action planning (19). This encourages a person to think in advance how to implement the desired behaviour and how to address challenges, reducing the cognitive load when these situations are faced (73).…”

“…For those who answer yes to having children, most RLPs go on to ask how many children an individual wou like, when they would like to have those children, and what method of contraception will be used to prevent pregnancy until the desired time. Some of the longer RLPs also asked about/mentioned preconception health e.g asking about health behaviours, health problems or medications, however this was rare for RLPs in the published literature (n=5) (14,19,20,43,51). For those that answer no, most RLPs ask how an individual will prevent pregnancy.…”

Contraceptive congruence: acknowledging pregnancy ambivalence in a novel measure of contraceptive use

“…The parent study tested the effectiveness of web-based interventions to assist insured self-identified women in making individualized contraceptive choices (ClinicalTrials.gov identifier:). 8 Study participants were members of Highmark Health plans in Pennsylvania and sampled from the Highmark enrollee database. Eligible self-identified women were aged 18-40, not intending pregnancy in the next 12 months, not surgically sterile (or current partner with vasectomy), sexually active with reported male partner(s), and had Internet access.…”