Strategies for communicating contraceptive effectiveness

Lopez, Laureen M; Steiner, Markus J.; Grimes, David A.; Hilgenberg, Deborah; Schulz, Kenneth F.

doi:10.1002/14651858.cd006964.pub3

Cited by 39 publications

(37 citation statements)

References 55 publications

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“…Relative effectiveness -as well as the likelihood of side-effects -can be hard to convey in counselling. [21] Job aids may facilitate this, but some recommend simply discussing contraceptive options in order of effectiveness from highest (LARCs) to lowest. [22,23] This 'LARC-first' approach to counselling extends, in some settings, to LARCs being promoted explicitly as first-line contraception and other methods as second-tier.…”

Section: Discussionmentioning

confidence: 99%

User perspectives on Implanon NXT in South Africa: A survey of 12 public-sector facilities

et al. 2017

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Background. Implanon NXT, a long-acting reversible contraceptive, was introduced in South Africa (SA) in early 2014, aiming to expand the method mix and increase its effectiveness. Initial uptake was high, but has since declined considerably. In these early years after the implant's introduction, it is important to identify reasons for the decline, and remedy gaps in services. Objectives. To determine periods of use, reasons for the use and early removal of the implant Implanon NXT. Methods. In 2016, we recruited 152 women from six clinics in the City of Johannesburg, and six in North West Province, SA. A semistructured interview was administered to 91 women currently using the implant and 61 previous users. We examined user perspectives, factors influencing women's experiences with the implant and reasons for discontinuation. Results. The participants' mean age was 30 years, with only 15% aged <25. Implant uptake was motivated by convenience (less frequent visits required than for short-acting methods) and by favourable views of the method among friends, family and healthcare providers. Only about a quarter of women recalled being counselled pre-insertion about implant effectiveness, and half about side-effects pre-insertion. Among discontinuers, the median time to device removal was 8 months (interquartile range 6 -12), and this was primarily as a result of sideeffects (90%), especially bleeding-pattern changes and headaches. Removals were most common among married and cohabiting women, often ascribed to the effects of bleeding on their sexual relationships. Rumours and misinformation contributed to some removals. Overall, women's experiences with the implant were rated 'good' or 'very good' by 74% of those continuing use, many of whom reported not having experienced any side-effects or that these had diminished over time. Conclusion. Levels of acceptability among continuing users were high, mainly linked to the method's convenience. While early favourable views drove uptake, negative perceptions, if unaddressed, may now undermine services. Deficiencies in counselling around effectiveness and side-effects may extend to contraceptive services more generally. Women require more intensive support when experiencing sideeffects, including effective systematic approaches to ameliorating bleeding and headaches. Implant services could specifically target young women and first-time contraceptive users. These actions together could reverse the persistent decline in implant use in SA.

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Section: Discussionmentioning

confidence: 99%

User perspectives on Implanon NXT in South Africa: A survey of 12 public-sector facilities

et al. 2017

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“…71 This review concluded that audio-visual aids were more effective than oral communication, and that presenting contraceptive efficacy with respect to categories of effectiveness, rather than exact numbers, was preferable. We suggest the WHO tiered counseling chart as a model, which has been shown to effectively improve knowledge of relative contraceptive efficacy.…”

Section: What Are Best Practices For Contraceptive Counseling?mentioning

confidence: 99%

Contraceptive Counseling

Dehlendorf¹,

Krajewski²,

Borrero³

2014

Clinical Obstetrics &Amp; Gynecology

295

143

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Improving the quality of contraceptive counseling is one strategy to prevent unintended pregnancy. We identify aspects of relational and task-oriented communication in family planning care that can assist providers in meeting their patients’ needs. Approaches to optimizing women's experiences of contraceptive counseling include working to develop a close, trusting relationship with patients and using a shared decision-making approach that focuses on eliciting and responding to patient preferences. Providing counseling about side effects and using strategies to promote contraceptive continuation and adherence can also help optimize women's use of contraception.

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“…Despite high rates of unintended pregnancy and sexually transmitted infection (STI) in the United States, and public health goals to reduce prevalence [1], surprisingly little research has identified effective counseling approaches for use in clinical settings to influence sexual risk behavior [2, 3]. A number of theory-driven interventions to reduce HIV/AIDS acquisition and transmission have been successful in community and clinic settings, but generally are implemented with specially trained study staff [4,5].…”

Section: Introductionmentioning

confidence: 99%

“I Wouldn’t Be this Firm if I Didn’t Care”: Preventive clinical counseling for reproductive health

Henderson

Raine

Schalet

et al. 2011

Patient Education and Counseling

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Objective-This qualitative study of the health care clinicians serving women at heightened risk of sexually transmitted infections and unintended pregnancy was undertaken to explore concepts underlying reproductive health counseling messages in clinical encounters.Methods-In-depth interviews were conducted with 31 clinicians, including physicians and advanced practice clinicians serving primarily low-income patients in high-risk communities throughout the U.S.Results-Most of the clinicians describe their influence on patients and protective behaviors as derived from medical authority and the presentation of information. The use of a parental style of authority, particularly for young or vulnerable patients, and emotional appeals to evoke negative emotions, such as fear, were also used to motivate protective behaviors. Many clinicians highlighted the importance of empathy, and understanding the cultural and social context of health behaviors. A few clinicians described innovative efforts to empower women to protect themselves and exert more control in relationships.Conclusion-Some of the reproductive health counseling approaches described by clinicians are not consistent with leading health behavior change theories or patient-centered counseling. To improve counseling, these messages and concepts need to be evaluated for effectiveness, and possibly used to inform the development of novel theories for use in reproductive health counseling.

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Strategies for communicating contraceptive effectiveness

Cited by 39 publications

References 55 publications

User perspectives on Implanon NXT in South Africa: A survey of 12 public-sector facilities

User perspectives on Implanon NXT in South Africa: A survey of 12 public-sector facilities

Contraceptive Counseling

“I Wouldn’t Be this Firm if I Didn’t Care”: Preventive clinical counseling for reproductive health

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