Results Summary
What was the research about?
Many kinds of birth control are available. In this study, the research team created a decision aid called My Birth Control to help women choose among birth control methods based on what’s most important to them. For example, a woman might want to take a pill every day instead of getting a shot every three months.
The research team wanted to see if the decision aid helped improve women’s experiences of choosing a birth control method. The team also looked at whether women continued to use birth control after several months.
What were the results?
The research team found no differences between women who did or didn’t use the decision aid in:
- Using the same birth control method four and seven months after the study started
- Interest in and use of birth control methods that are more effective at preventing pregnancy
- Number of unplanned pregnancies
- Satisfaction with their healthcare visit overall
- Whether they rated their visit as much better than their previous visit about birth control
But compared with women who didn’t use the decision aid, women who did:
- Were happier with discussions with their providers
- Felt like they knew all their options
- Knew more about birth control methods
- Were more satisfied with the information about side effects
- Felt surer about their birth control choice
Who was in the study?
The study included 758 English- and Spanish-speaking women getting care at four health clinics that serve patients with low incomes in San Francisco, California. Of these, 23 percent were white, 16 percent were Asian or Pacific Islander, 11 percent were African American, 11 percent were other races. Also, 39 percent were Hispanic or Latina. Almost half were under age 25.
What did the research team do?
The study included 28 healthcare providers working at the clinics. The providers were nurse practitioners, nurse midwives, physician assistants, or health educators. The research team assigned the providers by chance to either use or not use the decision aid with patients.
Patients using the decision aid looked at it on a tablet, in either English or Spanish, while waiting for their visit. They read about different birth control methods, answered questions about what was important to them about birth control, and checked off the methods they wanted to learn more about. The provider got a printout of this information. The patient and provider then talked about those methods during the visit. Providers who weren’t using the decision aid followed their regular procedures.
Patients filled out a survey right before and after their visit. They also took surveys four and seven months after their visit.
The research team worked with patients, providers, and staff from women’s health groups throughout the study.
What were the limits of the study?
Providers who didn’t use the decision aid may have talked about it with providers who did use it and may have changed how they talked with their patients.
All patients received care at health clinics that serve patients with low incomes in one city. Results might be different for patients who get care at other locations or types of clinics.
Future research could test how the decision aid works in other locations or with different groups of patients.
How can people use the results?
Clinics can offer this decision aid to patients who want to choose a birth control method.
Professional Abstract
Objective
To examine whether an interactive, tablet-based contraceptive decision aid plus contraceptive counseling improved contraceptive continuation compared with usual care
Study Design
| Design Elements | Description |
|---|---|
| Design | Cluster randomized controlled trial |
| Population | 758 female patients wishing to start or change contraceptive methods |
| Interventions/ Comparators |
|
| Outcomes |
Primary: continuation of the contraception method at 7 months Secondary: contraception continuation at 4 months, patient experience of counseling, quality of decision making, knowledge of contraception, use of and interest in highly effective contraception, unintended pregnancy |
| Timeframe | 7-month follow-up for primary outcome |
This randomized controlled trial compared use of contraceptive counseling with the My Birth Control decision aid against contraceptive counseling alone. Researchers randomized 28 healthcare providers at the clinics to provide contraceptive counseling as usual or have their patients use the My Birth Control decision aid in addition to usual care. The providers were nurse practitioners, nurse midwives, physician assistants, or health educators.
While waiting for their appointments, patients seeing providers in the intervention group received a tablet with the decision aid. Available in English and Spanish, the decision aid contained information relevant for choosing a contraceptive method, such as effectiveness, side effects, and mode and frequency of administration. Patients entered their birth control preferences into the decision aid, which summarized how patients’ preferences related to the different methods. Patients then selected methods to discuss with their providers. Providers viewed a printout of the summary during appointments. Providers in the usual-care group used their standard procedures to counsel patients about starting or switching a contraceptive method.
The study included 758 women with appointments at four clinics serving patients with low incomes in San Francisco, California. All patients wished to discuss starting or changing their contraceptive method. Of these, 23% were white, 16% were Asian or Pacific Islander, 11% were African American, 11% were other races, and 39% were Hispanic or Latina. In addition, 46% were 15 to 24 years old.
Patients completed surveys before and after their baseline visit and again four and seven months after the visit.
Patients, providers, and family planning organization representatives provided input to the study and to the development of the decision aid.
Results
Contraceptive continuation. The intervention and usual-care groups did not differ in patient-reported rates of continuing the same contraceptive at four (68% in intervention group versus 73% in usual-care group) or seven months (57% in intervention group versus 60% in usual-care group).
Patient experience of counseling. The intervention group rated their providers’ communication about birth control higher than those in the usual-care group (p=0.03). More patients in the intervention group also reported complete satisfaction with information given about contraceptive side effects (p=0.01). However, the groups did not differ in overall patient satisfaction with their visit or in ratings of their current visit compared with their previous birth control–related visit.
Quality of decision making. Compared with the usual-care group, patients in the intervention group were more likely to feel informed about their choices (p=0.05) and to feel certainty about their decision (p=0.03).
Knowledge. Compared with the usual-care group, patients in the intervention group had greater contraceptive knowledge after their counseling visit for 11 of the 24 knowledge measures (p<0.05).
Use of and interest in highly effective contraception and unintended pregnancy. The intervention and usual-care groups did not differ on any of these outcomes.
Limitations
Providers randomized to the intervention group may have discussed the decision aid with providers in the usual-care group, which could have affected providers’ conversations with patients. The study took place at clinics serving patients with low incomes. Results may not be generalizable at different types of health centers.
Conclusions and Relevance
Use of the My Birth Control decision aid did not affect contraceptive continuation compared with usual care. However, patients who used the decision aid experienced higher satisfaction for some measures of quality of counseling and had greater contraceptive knowledge after counseling.
Future Research Needs
Future research could explore the effectiveness of the decision aid in different settings, as well as among subpopulations of patients with specific needs, such as pregnant women and women with chronic medical conditions.
Final Research Report
View this project's final research report.
Journal Citations
Results of This Project
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers found the research study and report to be important and well-described. Researchers mostly addressed reviewers’ questions by adding information to the report.
- The reviewers asked the researchers to include additional information about the importance of unintended pregnancy as a patient-centered outcome as well as a public health outcome. The researchers added that there is some debate about whether unintended pregnancy is a patient-centered outcome, as it does not consider differences in the value or salience of unintended pregnancy among different women. The researchers focused instead on providing a tool that would help women make better-informed decisions about their birth control preferences.