Increasing uptake of long‐acting reversible contraception with structured contraceptive counselling: cluster randomised controlled trial (the LOWE trial)

Iwarsson, Karin Emtell; Envall, Niklas; Bizjak, Isabella; Bring, Johan; Kallner, Helena Kopp; Gemzell‐Danielsson, Kristina

doi:10.1111/1471-0528.16754

Cited by 20 publications

(34 citation statements)

References 24 publications

(75 reference statements)

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“…There was also no change in contraceptive use among those not already using prescription methods at S1, but a reduced reported likelihood of future method switching at follow-up. Most previously evaluated, effective video interventions have been delivered in tandem with clinical care, providing facilitated access to contraception post-education10 11 21 and our findings indicate, as demonstrated in prior research,18 19 that the accessibility of contraception after provider-independent or online education may more reliably predict uptake than participant knowledge and preference. Inequities according to age may be inferred by the confounding effect of this variable on contraceptive use outcomes (table 3).…”

Section: Discussionsupporting

confidence: 75%

“…LARC generally have high rates of continuation and attributes that make them desirable to many young people including their high effectiveness and generally acceptable side effect profiles 24–26. While videos that emphasise the benefits of LARC (primarily relating to their high effectiveness compared with other reversible methods) may increase LARC uptake,21 we note that the strongest desire to prevent pregnancy does not always correspond to a preference for the most effective methods 27–29. Contraceptive preference immediately after the video may have been biased towards LARC due to the presentation of contraceptive methods in the order of most to least effective.…”

Section: Discussionmentioning

confidence: 99%

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Can an online educational video broaden young women’s contraceptive choice? Outcomes of the PREFER pre-post intervention study

Mazza

Buckingham

McCarthy

et al. 2022

BMJ Sex Reprod Health

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IntroductionContraceptive knowledge mediates access and use. We aimed to assess whether an online educational video describing all methods and their benefits, side effects and mode of action increased young women’s contraceptive knowledge and their long-acting reversible contraception (LARC) preference and uptake.MethodWe used Facebook advertising to recruit young women aged 16–25 years. Participants completed the pre-video survey (S1), watched the 11-min video, then completed surveys immediately after (S2) and 6 months later (S3). Outcomes were analysed using McNemar tests and multivariate logistic regression (generalised estimating equations).ResultsA total of 322 participants watched the video, completed S1 and S2, and 88% of those completed S3. At S1 only 6% rated their knowledge about every method as high. Knowledge improved at S2 for all methods (OR 10.0, 95% CI 5.9 to 17.1) and LARC (OR 4.2, 95% CI 3.1 to 5.7). LARC preference increased at S2 (OR 1.7, 95% CI 1.4 to 2.1) and S3 (OR 1.4, 95% CI 1.2 to 1.7), as did LARC uptake at S3 (OR 1.3, 95% CI 1.11 to 1.5). LARC uptake was driven by a 4.3% (n=12) absolute increase in intrauterine device (IUD) use, but there was no change in contraceptive implant use (p=0.8). The use of non-prescription methods such as condoms and withdrawal did not change (OR 0.92, 95% CI 0.76 to 1.11).ConclusionsMany young women in Australia do not feel well informed about their contraceptive options. The contraceptive education video, delivered via social media, increased their self-reported contraceptive knowledge and IUD preference immediately after viewing, and their IUD uptake 6 months later. Focus should be given to how young women navigate contraceptive access after internet-based education, and strategies to increase access to preferred methods.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Can an online educational video broaden young women’s contraceptive choice? Outcomes of the PREFER pre-post intervention study

Mazza

Buckingham

McCarthy

et al. 2022

BMJ Sex Reprod Health

View full text Add to dashboard Cite

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“…Informed consent was signed prior to study participation. A detailed description of the LOWE trial has been published elsewhere 19…”

Section: Methodsmentioning

confidence: 99%

“…A study-specific intervention package for structured contraceptive counselling was used to present different contraceptive methods and their effectiveness, advantages and disadvantages 19. The package consisted of the following parts: an educational video, an effectiveness chart, four key questions, and a box with contraceptive models, all aiming to facilitate for the participant to make an informed decision on contraceptives.…”

Section: Methodsmentioning

confidence: 99%

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Long-acting reversible contraception and satisfaction with structured contraceptive counselling among non-migrant, foreign-born migrant and second-generation migrant women: evidence from a cluster randomised controlled trial (the LOWE trial) in Sweden

Iwarsson

Larsson

Bizjak

et al. 2022

BMJ Sex Reprod Health

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ObjectiveThis trial aimed to evaluate effects of structured contraceptive counselling among non-migrants, foreign-born migrants and second-generation migrants.MethodsA cluster randomised controlled trial was conducted in 2017–2019 at abortion, youth and maternal health clinics in Stockholm, Sweden (the LOWE trial). Patients were eligible if they were 18 years or older, could understand Swedish or English (or if assisted by an interpreter), were sexually active or planning to be, and were seeking contraception for pregnancy prevention. We randomised clinics at a 1:1 allocation ratio to give either structured contraceptive counselling (intervention) or to maintain standard contraceptive counselling (control). Blinding was not deemed feasibile. A study-specific package for structured contraceptive counselling was used and comprised an educational video, an effectiveness chart, four key questions and a box with contraceptive models. Outcomes were effects of the intervention on long-acting reversible contraception (LARC) choice, initiation and use, and satisfaction with the intervention material among the participants.ResultsWe involved 14 clinics in each of the intervention and control groups, respectively. A total of 1295 participants were included: 1010 non-migrants, 169 foreign-born migrants and 116 second-generation migrants. Participants in the intervention group chose LARC to a higher extent than the control group (adjusted OR (aOR) 2.85, 95% CI 2.04–3.99), had higher LARC initiation rates (aOR 2.90, 95% CI 1.97 to 4.27) and higher LARC use within the 12-month follow-up period (aOR 2.09, 95% CI 1.47 to 2.96). The majority of the participants who received the intervention package found all the different parts to be supportive in contraceptive choice. The effectiveness chart was the only part of the package that a higher proportion of foreign-born migrants (58/84, 69%) and second-generation migrants (40/54, 74.1%) found supportive in contraceptive choice compared to non-migrants (259/434, 59.7%) (p = 0.048).ConclusionsStructured contraceptive counselling increased LARC choice, initiation and use, controlled for participants’ migration background. The effectiveness chart was found to be significantly more supportive among foreign-born migrants and second-generation migrants compared to non-migrants when choosing contraceptive methods.Trial registration numberNCT03269357.

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Pillenmüdigkeit? Fakten und Auswirkungen

Tschudin

2021

Gynäkologische Endokrinologie

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Zusammenfassung Hintergrund In den letzten Jahren scheint sich ein Trend zu Alternativen für die „Pille“ abzuzeichnen. Fragestellung Es stellt sich die Frage, was es mit der postulierten „Pillenmüdigkeit“ auf sich hat, ob tatsächlich eine Abkehr von der hormonellen Kontrazeption stattfindet, was mögliche Gründe dafür sein könnten und ob sich Auswirkungen feststellen lassen. Material und Methoden Es wurde eine Literaturrecherche zu folgenden Punkten durchgeführt: 1. Hinweise auf Veränderungen im Verhütungsverhalten in Deutschland, Österreich und der Schweiz, 2. Evidenz in Bezug auf die zurzeit viel diskutierten Auswirkungen hormoneller Kontrazeptiva auf Psyche und Sexualität und 3. Hinweise auf eine Zunahme der Schwangerschaftsabbrüche. Ergebnisse Die Verwendung der Pille zeigt eine rückläufige Tendenz. Zurzeit lässt sich keine Aussage machen, ob es zu einer signifikant häufigeren Anwendung der Kupferspirale gekommen ist. Die Sorge vor Nebenwirkungen ist für einen beträchtlichen Prozentsatz der befragten Frauen ein wesentlicher Grund, hormonelle Verhütungsmittel zu vermeiden. Gemäß aktuellen Übersichtsbeiträgen verzeichnen die meisten Frauen, die kombinierte orale Kontrazeptiva verwenden, keine oder eine positive Wirkung auf die Stimmung, die Inzidenz einer depressiven Symptomatik ist gering und nur in Untergruppen relevant. Die Auswirkungen hormoneller Kontrazeptiva auf die Sexualität der Frau sind nicht ausreichend untersucht und die verfügbaren Daten deuten darauf hin, dass nur eine Minderheit eine positive oder negative Veränderung wahrnimmt. Eine Zunahme der Schwangerschaftsabbrüche zeichnet sich nicht ab. Schlussfolgerung In Anbetracht des Stellenwerts, den unter anderem die Nebenwirkungen bezüglich Zufriedenheit mit und Adhärenz zur Verhütungsmethode haben, ist eine individuell zugeschnittene Kontrazeptionsberatung essenziell.

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Increasing uptake of long‐acting reversible contraception with structured contraceptive counselling: cluster randomised controlled trial (the LOWE trial)

Abstract: Objective To evaluate the effect of structured contraceptive counselling on the uptake of long-acting reversible contraceptives (LARCs) and pregnancy rates.Design Cluster randomised trial.

Cited by 20 publications

References 24 publications

Can an online educational video broaden young women’s contraceptive choice? Outcomes of the PREFER pre-post intervention study

Can an online educational video broaden young women’s contraceptive choice? Outcomes of the PREFER pre-post intervention study

Long-acting reversible contraception and satisfaction with structured contraceptive counselling among non-migrant, foreign-born migrant and second-generation migrant women: evidence from a cluster randomised controlled trial (the LOWE trial) in Sweden

Pillenmüdigkeit? Fakten und Auswirkungen

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