Using the Healthcare Visit to Improve Contraceptive Use

Consistent and correct use of an effective contraceptive method is a primary determinant in preventing pregnancy. Unfortunately, only a minority of healthcare providers adequately address women's contraceptive needs. We have developed a standardized behavioral-based contraceptive counseling model that can be used by providers and other clinic staff to address this limitation. The model, ESP, is an adaptation of motivational interviewing and involves: Exploring discrepancies between pregnancy intention and contraceptive use and between risk of STDs and condom use; Sharing information; and Promoting behaviors to reduce risk.

Study question: Does ESP counseling lead to an increase in consistency and effectiveness of contraceptive use among women at risk of unintended pregnancy?

Methods: Randomized controlled trial of 747 women, ages 16-44, at self-identified risk of unintended pregnancy enrolled from March 2003 to September 2004 at healthcare settings in North Carolina. Intervention participants received individualized ESP counseling from a health educator to address barriers to effective and consistent contraceptive use. Risk reduction steps were negotiated. Pregnancy, Chlamydia infection and contraceptive use were assessed at baseline and follow-up. "Highly effective" contraceptive use was defined as a combination of effectiveness and consistency. Women in the control arm received general preventive health counseling (e.g., smoking and exercise). Differences between the study arms at 12-months may illustrate the longer term influence of the intervention.

Inclusion criteria

• Women aged 16-44
• English-speaking
• Do not wish to be pregnant or unsure of pregnancy intention
• Have an appointment for non-acute care
• Currently using no method of contraception, inconsistent use of methods, pills, condoms, diaphragms, periodic abstinence, or methods associated with higher pregnancy rates
• Ability to read at least at 8th grade level
• Willing to participate in follow-up visits at 2, 8, and 12 months
• Able to be contacted by telephone

Exclusion criteria

• Women less than 16 or greater than 44 years
• Women who are sterilized, or whose partners are sterilized or who use the IUD for contraception
• Appointments for acute care
• Non-English speaking
• Inability to read at or above 8th grade level
• Pregnant at time of enrollment
• Lack of ability for telephone contact