The impact of an educational text message intervention on young urban women's knowledge of oral contraception

Abstract

Background Oral contraceptive (OC) knowledge deficits may contribute to OC discontinuation. We examined the effect of an innovative educational intervention on young women’s OC knowledge. Study Design As part of a randomized trial evaluating the impact of text message reminders on OC continuation, we assessed OC knowledge in 659 women ages 13-25 years. Women received routine care or routine care plus six months of daily educational text messages. We administered a comprehensive 41-item OC knowledge survey at baseline and six months. Results Mean OC knowledge scores improved over time for all women (baseline 22.8, 56% correct versus 24.7, 60% at six months), including knowledge of OC’s mechanisms of action (p=0.004), effectiveness (p<0.001), side effects (p=0.03), and benefits (p<0.001). Mean six-month scores were greater in the intervention (25.5) than the control group (23.7)(p<0.001). In multivariable linear regression models, the text message intervention most strongly predicted OC knowledge (β=1.6, 95% CI 0.9, 2.2). Conclusion Daily educational text messages can modestly improve knowledge of OCs, which may promote successful contraceptive outcomes.

The Influence of Oral Contraceptive Knowledge on Oral Contraceptive Continuation Among Young Women

“…In our previous in-depth analysis of the different dimensions of OC knowledge, we described women's gaps in OC knowledge, which were greatest for OC side effects, risks and benefits. 12 Collectively, our results may reflect specific areas to target in efforts to educate women on all key dimensions of OCs (rather than emphasizing risks or side effects). Such a comprehensive approach could potentially have a stronger impact on OC continuation rates.…”

“…12 In the present analysis, because we were interested in understanding the effect of OC knowledge on continuation, we attempted to account for this potential confounding by using comprehensive pre-post OC knowledge assessments, by controlling for the treatment effect and by further stratifying the analysis by intervention groups. Nonetheless, further research is needed to isolate the influence of OC knowledge on behavior and to understand the multilevel, and even interactive, effects of technological health intervention components on family planning knowledge and behaviors.…”

“…Potential covariates, including sociodemographic and reproductive correlates we had previously shown to be associated with OC knowledge and continuation, were considered for inclusion in regression models if their p-value in bivariate tests was £ 0.25. 11,12 We present final reduced multivariable models in which we retained only those covariates that were associated with OC knowledge or continuation at p < 0.05. For variables that appeared to be collinear (e.g., age and grade of education), we retained those variables with the strongest effect.…”

“…11 We described the sample and reported on the main text message intervention effects on OC continuation and OC knowledge elsewhere. 11,12 In brief, young women presenting to an urban family planning health center requesting OCs were informed of the study and asked to participate. Women eligible for inclusion were (1) aged 13-25 years, (2) currently sexually active, (3) owners of a cell phone with text messaging capabilities, and (4) specifically requesting OCs.…”

“…We have described the questionnaire in more detail elsewhere. 12 Briefly, information from comprehensive, standardized handouts from the clinical site was used to develop the knowledge questions. Question formats included true-false (10 items), multiple choice (15 items), and alternate choice (16 items).…”