Combining Qualitative with Quantitative Approaches to Study Contraceptive Pill Use

Abstract

According to large-scale studies, oral contraceptive users become pregnant at rates that exceed ideal use failure rates. It is thought that a major cause is missed pills, but current research on consistent contraceptive pill taking is characterized by inadequate measures and a failure to investigate women's thinking about their own patterns of use. The purpose of this study was to gain some understanding about women's interpretations of consistency in their own pill taking through combining qualitative with quantitative data. The study was conducted in China, where contraception is free and widely available. Five urban and five rural oral contraceptive users were followed for up to three pill-taking cycles during 1996 for a total of 759 person-days. Consistency of pill taking was measured with electronic data obtained from a new blister package made by Anderson Clinical Technologies (Elmhurst, IL). Data from these devices were reviewed and interpreted by the study participants during in-depth private interviews. The users' reasons for missing pills included disruptions in their daily routines, their husband's absence, spotting, and trouble implementing the family planning program's instructions to take one pill per day for 22 days and start the next cycle on the fifth day of menses. One user gave these reasons for two cycles but denied missing numerous pills in her third cycle. Data from a series of four questionnaires showed that most demographic, psychosocial, and service system characteristics were not related to missed pills. However, results suggested that the daily routines of rural living may make consistent use more likely and that instructions for taking the pill may be associated with prolonged pill-free intervals and skipping pills during episodes of spotting. Three of the 10 women were at increased risk of pregnancy during the study period because of their pill-taking pattern. We concluded that the combination of qualitative with quantitative data enhances understanding of contraceptive use. Women themselves offer plausible reasons for their use behaviors. Listening to women could be useful in improving programs.

Why Do Women Miss Oral Contraceptive Pills? An Analysis of Women's Self‐Described Reasons for Missed Pills

“…Although women's self‐reports of pill taking have been shown to underestimate the frequency of missed pills, 11 this study supports the conclusions of Oakley and colleagues, 13 which emphasize that there is useful information to be gathered when women are asked to explain their pill‐taking behavior in their own words. The findings of this study suggest that current health care interventions may not address the most common reasons OC users report for missing pills.…”

Attitudes of married individuals towards oral contraceptives: a qualitative study in Istanbul, Turkey

“…18 In a study from India the major complaints about the pill were nausea, giddiness and headache, 19 in Tasmania a slight increase in breast swelling and tenderness and weight gain 20 and in China spotting. 21 In a Finnish study the major concerns about OCs were cardiovascular effects, cancer, infertility, mood changes and weight gain. 22 In a Russian study to identify why the pill was so unpopular, focus group participants described the pill as harmful, ineffective, untrustworthy and difficult to obtain.…”

Building international partnerships

“…The results were incorporated into a National Institutes of Health (NIH) grant proposal, but as it was not funded, the project was not continued. A second project involved data that had been collected in China by the University of Michigan faculty, with the visiting scholars involved in data analysis and manuscript preparation (Oakley et al 1999).…”