Randomized Controlled Trial of Adjunctive Social Media for More Effective Contraceptive Counseling
Condition: Contraception
Study type: Interventional

Summary: 
      The scope of this project was to provide evidence that better contraceptive choices are made
      with more effective counseling as well as improvement in patients' contraceptive knowledge.
      Specifically we wanted to evaluate the use of social media as a means for effective patient
      counseling.
    

Detailed description: 
      This study was performed at an urban obstetrics/gynecology clinic at New York-Presbyterian
      Hospital-Weill Cornell Medical Center. Institutional review board approval for this trial was
      obtained from the Weill Cornell Medical Center.

      A total of 180 subjects, ages 18-45, were approached for enrollment into this study. Patients
      were eligible if they were scheduled for a new gynecologic visit, follow-up gynecologic
      visit, preconception counseling or post-partum visit. Patients who did not speak English or
      declined participation were ineligible as well as currently pregnant patients; 32 subjects
      were thus excluded. There were no exclusion criteria outside of age, language, currently
      pregnant status and willingness to participate. 148 patients met inclusion criteria and were
      randomized. 4 patients were excluded after randomization: 1 for not disclosing age, 3 for not
      completing the study (Figure 1). All patients provided written informed consent prior to
      randomization. Subjects in our population are a well-educated population. In a previous study
      conducted in the same clinic, 60% of women had some college education and another 29% had
      high school diploma or GED (unpublished data).

      Randomization was achieved through an opaque envelope system. Equal numbers of opaque
      envelopes contained slips of paper with the number 1 or 2, signifying to the investigators
      the randomization group of each subject. Subjects were randomized to either standard
      counseling + pamphlet education (n= 74) or standard counseling + Facebook education (n=70).
      After randomization and prior to any intervention, a validated contraceptive knowledge survey
      (Contraceptive Knowledge Inventory, CKI)10 was administered to the subjects. The survey
      contained 25 questions specifically addressing general contraceptive knowledge and
      risks/benefits associated with different contraceptive methods. The subjects had unlimited
      time to complete the pre-intervention survey. Patients were also questioned about demographic
      information, including gravidity, marital status, age, and race/ethnicity, and their
      currently used contraceptive, including no contraceptive. A single provider then provided
      standardized counseling for all subjects involved in the study, which was conducted
      one-on-one. Standard counseling included discussion of barrier, hormonal, surgical and
      implantable/intrauterine devices. 15 minutes was allocated per patient for standard
      counseling in both groups. The goal of the standard counseling was to simulate a 15-minute
      in-office consultation specifically addressing contraception. Only American Congress of
      Obstetricians and Gynecologists (ACOG) derived facts were used, and a transcript was followed
      by the single provider, who was an M.D., to guarantee uniformity. The ACOG pamphlets were
      chosen for content pertaining to the CKI. Once the pamphlets were chosen, the Facebook page
      was constructed to be identical in content to the ACOG pamphlets.

      Depending on the randomization group, patients were given 30 minutes to review ACOG patient
      education pamphlets specifically addressing contraception, or to interact with a Facebook
      page created by the investigators using identical content but in video, diagram and game
      format. The pamphlets were accessed on the ACOG website under patient education
      (www.acog.org). Following the intervention phase of the project, the subjects were
      administered the CKI again to assess post-intervention knowledge. At the completion of the
      post-intervention CKI, subjects were questioned regarding their preference for contraception
      and satisfaction with their counseling method. Subject satisfaction was measured in a similar
      fashion as clinical pain control. A 1-10 scale was used with 5 being neutral (i.e. the
      subject did not feel the method improves or negatively effects their counseling). A score of
      less than 5 was dissatisfaction with the counseling method and a score of greater than 5
      signified satisfaction. 10 was a perfect score and meant the subject felt the intervention
      provided a significant improvement in counseling method.
    

Intervention name(s): Facebook; Pamphlet
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Facebook page with contraception information used for counseling; Contraceptive knowledge pamphlets
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single (Participant)