Results Summary
What was the research about?
In the United States, 45 percent of pregnancies aren’t planned. A reproductive life plan based on a woman’s goals, resources, and values may help her decide whether, when, and how to have children.
In this study, the research team wanted to learn if a website on reproductive life planning helped women to choose and use birth control. The team also wanted to know if the website worked better when used with an action plan. In action planning, a woman makes plans for dealing with barriers to using birth control, such as how to remember to take a pill every day.
What were the results?
The research team didn’t find differences in birth control use among women who used reproductive life planning, reproductive life planning plus action planning, or only received information on birth control. Use of birth control increased for all groups during the study. Use of long-acting, reversible contraceptives, such as hormonal implants and intrauterine devices, or IUDs, also increased in all groups.
Who was in the study?
The study included 984 women who had health insurance with a company in Pennsylvania. Most of the women were white (94 percent), had graduated from college (93 percent), and had no children (68 percent). In addition, 45 percent of women were ages 18 to 25, 37 percent were ages 26 to 33, and 18 percent were ages 34 to 40. None of the women were planning to get pregnant in the next year. At the start of the study, 88 percent of women were using some form of birth control, and 12 percent reported using no birth control.
What did the research team do?
At the start of the study, all women in the study took a survey. The team then assigned the women to one of three groups by chance. The first group viewed an interactive website on reproductive life planning. Information on the site came from the U.S. Centers for Disease Control and Prevention. The information helped women decide if they wanted to become pregnant based on their current life goals. The website also gave women information on pregnancy and the birth control options that met their needs. The second group viewed the same website and completed an action plan for their current form of birth control. The third group viewed a website with standard information on common forms of birth control. All groups completed follow-up surveys and revisited their website every six months during the two-year study.
What were the limits of the study?
Most women in the study were white and well-educated. Also, all women had private health insurance and were from only one state. The findings may have been different with women from other backgrounds. At the start of the study, most women already used birth control and were satisfied with their choices. They may have already known about their birth control options.
Future studies could include women from different backgrounds. Future research could also focus on women who don’t always use birth control or on women who want to change their birth control method.
How can people use the results?
Researchers can use the results from this study to learn more about reproductive life planning and action planning programs.
Professional Abstract
Objective
To test whether reproductive life planning alone or in combination with contraceptive action planning increases contraceptive use and adherence among women compared with information about contraception only
Study Design
| Design Element | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 984 women ages 18–40 |
| Interventions/ Comparators |
|
| Outcomes |
Any contraceptive use, prescription contraceptive use, contraceptive use congruency with pregnancy intention, contraceptive adherence, a change to a more effective contraceptive method |
| 2-year follow-up for study outcomes |
This randomized controlled trial compared the effectiveness of reproductive life planning alone, reproductive life planning plus contraceptive action planning, and contraceptive information alone on women’s contraceptive use and adherence. In reproductive life planning, individuals set goals for having or not having children and make a plan to achieve those goals. In contraceptive action planning, individuals make a specific plan for what they will do when faced with common obstacles to using contraception.
The study included 984 women who were insured by a large private health insurer in Pennsylvania. Most of the women were white (94%), had graduated from college (93%), and had no children (68%). Of the women in the study, 45% were ages 18 to 25, 37% were ages 26 to 33, and 18% were ages 34 to 40. All of the women had coverage for prescription medication and were not planning to become pregnant in the next 12 months. At baseline, 50% of women were using short-acting prescription methods, 30% were using nonprescription methods, 12% reported using no method, and 8% were using long-acting, reversible contraceptives (LARC), such as intrauterine devices or hormonal implants.
All women completed a baseline survey. The research team then randomly assigned women to one of three groups. The first group viewed an interactive website adapted from the Centers for Disease Control and Prevention’s reproductive-life-planning tool. The website helped women determine if they wanted to become pregnant based on their current life circumstances and goals. The website also provided information to help each woman with individual decision making and displayed a summary of contraceptive options that met each woman’s needs. The second group viewed the same website and completed an action plan for the contraceptive method they were using, if any. The third group viewed a website with standard information on all contraceptive methods approved by the U.S. Food and Drug Administration. All groups completed follow-up surveys and revisited their assigned website every six months during the two-year study.
Patient and clinician advisory groups provided input to the research team throughout the study.
Results
After two years, there were no statistically significant differences among the three groups in any of the study outcomes. Overall contraceptive use and LARC use increased significantly among all groups during the study (p<0.05), but there were no differences among the three groups.
Limitations
Most women in the study were white and well-educated and all had private insurance and were from a single state, which may limit the generalizability of the findings. The study sample had relatively high contraceptive use and satisfaction at baseline, so participants may have already been knowledgeable about their contraceptive options.
Conclusions and Relevance
The study did not find evidence that reproductive life planning alone or combined with contraceptive action planning affects contraceptive use or adherence, compared with standard contraceptive information alone.
Future Research Needs
Future research could include women from different backgrounds. Future studies could also focus on women who express an interest in changing their method of contraception or have a problem with consistently using their current method.
Final Research Report
View this project's final research report.
More About This Research
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:
- Most reviewer comments requested that researchers provide additional details in the draft report, and the researchers did.
- Reviewers questioned the need for this study’s intervention given that there was already a high rate of contraception use in the target population. The researchers noted that while overall use was high, over 40 percent of women do not use the most effective contraceptive methods, which this study hoped to change.
- Reviewers asked whether the researchers considered including a true control comparison group that received no intervention. The researchers responded that they chose to provide the control group participants with basic birth control information as it’s widely available. The investigators also provided this information because they thought their study would be more useful by testing the added effect of reproductive life planning over and above this basic information.
- Reviewers asked about the addition of the method congruence outcome, which did not seem patient centered. The researchers responded that this outcome was actually patient centered. The investigators explained that they added the outcome in response to the patient advisory group’s suggestion to address situations in which a woman chose a birth control method that may not be most effective but would be most congruent with her own beliefs and expectations.
- The reviewers identified a potential problem with the contraceptive satisfaction variable. The reviewers found that someone completing the survey once counted equal to someone who completed the survey multiple times, even though the latter provided more data. The researchers acknowledged that while this could be a problem for respondents who completed the survey during only one survey period, the high response rate at each survey period mitigated that concern.
Conflict of Interest Disclosures
View the COI disclosure form.
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:
- Most reviewer comments requested that researchers provide additional details in the draft report, and the researchers did.
- Reviewers questioned the need for this study’s intervention given that there was already a high rate of contraception use in the target population. The researchers noted that while overall use was high, over 40 percent of women do not use the most effective contraceptive methods, which this study hoped to change.
- Reviewers asked whether the researchers considered including a true control comparison group that received no intervention. The researchers responded that they chose to provide the control group participants with basic birth control information as it’s widely available. The investigators also provided this information because they thought their study would be more useful by testing the added effect of reproductive life planning over and above this basic information.
- Reviewers asked about the addition of the method congruence outcome, which did not seem patient centered. The researchers responded that this outcome was actually patient centered. The investigators explained that they added the outcome in response to the patient advisory group’s suggestion to address situations in which a woman chose a birth control method that may not be most effective but would be most congruent with her own beliefs and expectations.
- The reviewers identified a potential problem with the contraceptive satisfaction variable. The reviewers found that someone completing the survey once counted equal to someone who completed the survey multiple times, even though the latter provided more data. The researchers acknowledged that while this could be a problem for respondents who completed the survey during only one survey period, the high response rate at each survey period mitigated that concern.