Ten best practices of contraceptive counseling, and integrating them into a counseling protocol

After an in-depth review of the extant literature on contraceptive counseling, ten best practices were identified and combined into a comprehensive contraceptive counseling protocol. Two of the practices --  demonstrating trustworthiness, expertise, and accessibility, and using active and memorable learning strategies -- are used throughout the counseling session. The other practices were discrete strategies.  These include introducing all method options through a visual tool, considering how methods fit with the broader lifestyle of the patient, addressing accurate and consistent use, discussing dual use, addressing side effects ahead of time, forming a contingency plan for switching as needed, discussing the influence of pregnancy ambivalence on method use, and reminding patients that they can most likely start their method that day.

To create an intervention to convey all ten practices in counseling, we designed a trainer guide which served as the basis for a one day training agenda. This eight hour training included a presentation of practices, videos with role plays, role play activities, and worksheets for the practices that were the greatest departure for the standard of care. We gave counselors the opportunity to share myths they have heard about methods and debunked them as a group. The one day training was followed by two days of on-site shadowing by one of the training facilitators. Feedback during shadowing was provided to counselors both immediately following counseling and at the end of the day. Counselors were left with all the necessary materials including fidelity checklists to be completed following each counseling session.