using the healthcare visit to improve contraceptive use

Conditions: Pregnancy; Chlamydia

Summary: consistent and correct use of an effective contraceptive method is a primary determinant in preventing pregnancy. unfortunately, only a minority of healthcare providers adequately address women's contraceptive needs. we have developed a standardized behavioral-based contraceptive counseling model that can be used by providers and other clinic staff to address this limitation. the model, esp, is an adaptation of motivational interviewing and involves: exploring discrepancies between pregnancy intention and contraceptive use and between risk of stds and condom use; sharing information; and promoting behaviors to reduce risk. study question: does esp counseling lead to an increase in consistency and effectiveness of contraceptive use among women at risk of unintended pregnancy? methods: randomized controlled trial of 747 women, ages 16-44, at self-identified risk of unintended pregnancy enrolled from march 2003 to september 2004 at healthcare settings in north carolina. intervention participants received individualized esp counseling from a health educator to address barriers to effective and consistent contraceptive use. risk reduction steps were negotiated. pregnancy, chlamydia infection and contraceptive use were assessed at baseline and follow-up. "highly effective" contraceptive use was defined as a combination of effectiveness and consistency. women in the control arm received general preventive health counseling (e.g., smoking and exercise). differences between the study arms at 12-months may illustrate the longer term influence of the intervention.

consistent and correct use of an effective contraceptive method is a primary determinant in preventing pregnancy. unfortunately, only a minority of healthcare providers adequately address women's contraceptive needs. we have developed a standardized behavioral-based contraceptive counseling model that can be used by providers and other clinic staff to address this limitation. the model, esp, is an adaptation of motivational interviewing and involves: exploring discrepancies between pregnancy intention and contraceptive use and between risk of stds and condom use; sharing information; and promoting behaviors to reduce risk. study question: does esp counseling lead to an increase in consistency and effectiveness of contraceptive use among women at risk of unintended pregnancy? methods: randomized controlled trial of 747 women, ages 16-44, at self-identified risk of unintended pregnancy enrolled from march 2003 to september 2004 at healthcare settings in north carolina. intervention participants received individualized esp counseling from a health educator to address barriers to effective and consistent contraceptive use. risk reduction steps were negotiated. pregnancy, chlamydia infection and contraceptive use were assessed at baseline and follow-up. "highly effective" contraceptive use was defined as a combination of effectiveness and consistency. women in the control arm received general preventive health counseling (e.g., smoking and exercise). differences between the study arms at 12-months may illustrate the longer term influence of the intervention.

Eligibility criteria:
inclusion criteria: * women aged 16-44 * english-speaking * do not wish to be pregnant or unsure of pregnancy intention * have an appointment for non-acute care * currently using no method of contraception, inconsistent use of methods, pills, condoms, diaphragms, periodic abstinence, or methods associated with higher pregnancy rates * ability to read at least at 8th grade level * willing to participate in follow-up visits at 2, 8, and 12 months * able to be contacted by telephone exclusion criteria: * women less than 16 or greater than 44 years * women who are sterilized, or whose partners are sterilized or who use the iud for contraception * appointments for acute care * non-english speaking * inability to read at or above 8th grade level * pregnant at time of enrollment * lack of ability for telephone contact