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133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA |
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Ruth Petersen, MD, MPH1, Jennifer Albright, MPH2, Hayley Holland, MPH2, Patricia Payne, CNM, MPH3, Valerie King, MD, MPH4, and Kathryn M. Curtis, PhD5. (1) Department of Obstetrics and Gynecology and Center for Women's Health Research, University of North Carolina, CB # 7521, 725 Airport Road, Chapel Hill, NC 27599-7521, 919-966-7924, ruth_petersen@unc.edu, (2) Sheps Center for Health Services Research, University of NC, CB # 7521, Chapel Hill, NC 27599-7521, (3) School of Nursing, East Carolina University, Rivers RW309, Greenville, NC 27858, (4) Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-7591, (5) National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop K34, Atlanta, GA 30341
Objectives: To evaluate a behavioral-based, contraceptive counseling intervention administered by health educators.
Method: Randomized controlled trial of 747 women at risk of unintended pregnancy enrolled from March 2003 to September 2004 at primary health care settings. Intervention participants received individualized counseling, using a modification of motivational interviewing, to address barriers to effective and consistent contraceptive use and other sexual risk-taking behaviors. Risk reduction steps were negotiated. Pregnancy, Chlamydia, and behavioral outcomes were assessed.
Results: At baseline, 79% of participants did not want to be pregnant and 21% were unsure about whether or not they wanted to be pregnant. Baseline contraceptive use included: oral contraceptives (37%); condoms (36%); withdrawal, fertility awareness, or emergency contraception (16%); IUD, Depo-Provera or Norplant (12%); and other (8%). When examining contraceptive use by effectiveness and consistency, 59% of participants reported highly effective use; 19%, less effective use; and 21%, no method use. Intervention participants (n= 363) reported barriers to contraceptive use and selected risk reduction steps within 5 categories including: continue current method, increase consistency of method, start or re-start a method, obtain medical follow-up, or think about starting a method. At the 2-month follow-up, completion rates of steps, by category, were 90%, 66%, 75%, 47%, 81% respectively.
Discussion: Despite a lack of desire for pregnancy, over 40% of women did not report highly effective method use. Women reported barriers to contraceptive use but were willing to negotiate risk reduction steps. Differences between the study arms at 12-months will illustrate the potential influence of the intervention.
Learning Objectives:
Keywords: Contraception, Counseling
Presenting author's disclosure statement:
I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.
The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA