Improvement in contraceptive knowledge after using an online educational resource.

OBJECTIVES: To measure the change in contraceptive knowledge after interaction with a web-based contraception education resource in an online cohort of potential users. STUDY DESIGN: We conducted a cross-sectional online survey of reproductive-aged, biologically female respondents using Amazon Mechanical Turk. Respondents provided demographic characteristics and responded to 32 contraceptive knowledge questions. We assessed contraceptive knowledge before and after interaction with the resource and compared the number of correct answers using Wilcoxon signed-rank test. We used univariate and multivariable logistic regression to identify respondent characteristics associated with an increase in the number of correct answers. We calculated System Usability Scale scores to assess ease of use. RESULTS: A convenience sample of 789 respondents were included in our analysis. Prior to resource use, respondents had a median of 17/32 correct contraceptive knowledge responses (interquartile range [IQR] 12-22). The number of correct answers increased to 21/32 (IQR 12-26, p < 0.001) after viewing the resource; 556 (70.5%) had an increase contraceptive knowledge. In adjusted analyses, respondents who were never married (adjusted odds ratio [aOR] 1.47, 95% CI 1.01-2.15), or thought decisions about birth control should be made by themselves (aOR 1.95, 95% CI 1.17-3.26) or in conjunction with a clinician (aOR 2.09, 95% CI 1.20-3.64) were more likely to have an increase in contraceptive knowledge. Respondents reported a median system usability score of 70 out of 100 (IQR 50-82.5). CONCLUSIONS: These results support the effectiveness and usability of this online contraception education resource among this sample of online respondents. The educational resource could effectively augment contraceptive counseling in the clinical setting. IMPLICATIONS: Use of an online contraception education resource improved contraceptive knowledge among reproductive-age users.

Young women's preferences for contraceptive education & development of an online educational resource.

Objectives: To explore young women's preferences for contraceptive education to inform the development of an educational resource and to pilot test the resource with patients and clinicians. Methods: We performed a mixed-methods study to elicit preferences for contraceptive educational resources among patients, develop an online resource, and pilot test the resource with clinicians and patients to assess feasibility, systems usability, and contraceptive knowledge. Results: Forty-one women aged 16-29 completed in-depth interviews: they preferred an online format which was recommended by a clinician, presented contraceptive methods in order of effectiveness, and contained information from experts and experiences from individual users. We adapted an existing website (bedsider.org) to create an online educational resource. Thirty clinicians and thirty patients completed surveys after use. System Usability Scale scores were high among patients (median [IQR]: 80 [72-86]) and clinicians (84 [75-90]). Patients answered more contraceptive knowledge questions correctly after interacting with the resource (9.9±2.7 vs 12.0±2.8, p<0.001). Conclusions: We developed a contraceptive educational resource incorporating end-user feedback that was highly usable and increased patients' contraceptive knowledge. Future research should assess effectiveness and scalability among a larger sample of patients. Innovation: This contraceptive educational resource can supplement clinician counseling to increase patient contraceptive knowledge.

Young women's preferences for contraceptive education: The importance of the clinician in three U.S. health centers in 2017-2018.

OBJECTIVE: We explored women's preferences for contraceptive education and assess the role of the clinician in delivering this education in three U.S. health centers in 2017-2018. STUDY DESIGN: We recruited women ages 16 to 29 presenting for gynecologic care at 3 clinical sites. Respondents completed a survey about preferences for receipt of contraceptive information and trustworthiness of information sources. RESULTS: We included 270 respondents' surveys (77.6% of approached). Clinicians were the most preferred (87.0%) and trusted (83.5%) source of contraceptive information, and 69.0% said a clinician's recommendation made a source more trustworthy. CONCLUSIONS: Clinicians are a trusted source of contraceptive information; their recommendations of other educational resources may improve acceptance by patients.

Decisional conflict associated with clinicians discouraging particular contraceptive methods.

RATIONALE, AIMS, AND OBJECTIVES: Approximately 45% of pregnancies in the United States are unintended. The use of contraception reduces the risk of unintended pregnancy. The initiation of several contraceptive methods requires seeing a clinician. This study explored how clinicians' expressed preferences against particular contraceptive methods impacted participants' confidence in their method choice and perception of shared contraceptive decision making. METHODS: Eligible individuals were 18 to 45 years of age, assigned female sex at birth, English speaking, and either using or had previously used contraception. Participants completed an anonymous survey via web link on Amazon Mechanical Turk. Primary self-reported outcomes were (a) proportion of participants being discouraged from a particular contraceptive method, (b) decisional conflict, and (c) extent of shared decision making. Secondary self-reported outcomes were (a) importance of contraceptive attributes and (b) self-reported quality of care. RESULTS: Six hundred sixty-nine participants completed the survey. Most were white (74.0%), non-Hispanic (84.5%), married or cohabitating (69.4%), and nulliparous (47.2%). A total of 33.8% reported that a clinician had discouraged them from using a particular contraceptive method, most commonly because of side effects, usability, and/or method effectiveness. Effectiveness, affordability, and side effects were the self-reported most important contraceptive features. Those who were discouraged from using a method (versus those who were not) were more likely to report decisional conflict (41.2% vs 30.0%, P = .004), yet reported a higher extent of shared decision making (median: 76 vs 71; P = .03). Adjusting for age and nulliparity did not impact results, except nulliparity made the relationship between being discouraged from using a method and shared decision making no longer significant (P = .06). CONCLUSIONS: Decisional conflict might arise when clinicians discourage individuals using particular contraceptive methods. Clinicians' reasons for discouraging methods might not always align with patients' preferences. More research is needed to examine how to reduce decisional conflict and support contraceptive method selection.

Patient-Perceived Autonomy and Long-Acting Reversible Contraceptive Use: A Qualitative Assessment in a Midwestern, University Community.

Long-acting reversible contraceptives (LARCs) are the most effective contraceptives and are first-line recommendations for most women. However, young women use these methods at relatively low rates. Given concern with contraceptive coercion, an underexamined factor contributing to LARC attitudes is women's perceived reproductive and bodily autonomy in regard to LARC. We conducted focus group discussions and interviews regarding LARC perceptions and knowledge with 50 women between the ages of 18 and 29. We used a modified grounded theory approach to analyze young women's impressions of autonomy in relation to contraceptives more generally and LARC more specifically, both among ever-users and never-users. Four themes emerged regarding women's perceived autonomy with LARC. Control over pregnancy, active participation versus external agent, control over bleeding patterns, and autonomy in the provider/patient relationship. Within most themes, women made both positive and negative associations between perceived autonomy and LARC. The provider/patient relationship was a modifier of other themes, in that cooperative relationships may overshadow other perceived reductions in autonomy, and more unbalanced relationships may heighten perceived reductions in autonomy. Ever-users were more likely to report increased autonomy with LARC use, whereas never-users were more likely to express concerns about loss of autonomy with LARC. This study suggests that perceived autonomy may influence women's perceptions of LARC as well as their uptake of these contraceptive methods, with several factors both positively and negatively related to women's perceived autonomy. We encourage the integration of these findings into patient-centered counseling as well as educational materials for LARC.

The epidemiology of maternal overweight in Dane County, Wisconsin.

BACKGROUND: Research shows that maternal obesity leads not only to adverse pregnancy outcomes but also can act as a predictor of poor health of future generations. The Public Health Madison & Dane County Fetal and Infant Mortality Review Board observed poor health associated with prepregnancy BMI > or = 25, prompting further exploration of this issue in the Dane County, Wisconsin population. OBJECTIVE: This is a descriptive epidemiologic study of the problem of maternal overweight defined as prepregnancy BMI > or = 25 in Dane County. METHODS: Data were abstracted from the Secure Public Health Electronic Records Environment (SPHERE) on births in Dane County in 2011. Risk ratios were used to determine associations between race, education, parity, gravidity, and place of residence and maternal overweight. A t test was completed to determine differences in mean age of overweight and healthy weight mothers. RESULTS: Approximately half (50.6%) of Dane County mothers in 2011 were overweight or obese prepregnancy. Results showed increased risk of overweight for black mothers and multiparous/multigravidous mothers. There was no difference in mean age of overweight and healthy weight mothers. Overweight rates varied considerably by ZIP code of residence. CONCLUSION: Rates of maternal overweight vary significantly in Dane County by social and demographic factors. This information can be used to design and target interventions and monitor trends over time.