Elsevier

Obstetrics & Gynecology

Volume 102, Issue 4, October 2003, Pages 709-717
Obstetrics & Gynecology

Original research
Understanding risk: a randomized controlled trial of communicating contraceptive effectiveness

https://doi.org/10.1016/S0029-7844(03)00662-8Get rights and content

Abstract

Objective

To determine which of three different approaches increased women's understanding of risk of pregnancy associated with different contraceptive methods.

Methods

We randomly assigned 461 reproductive-age women to one of three tables presenting pregnancy risk (Food and Drug Administration table with numbers, World Health Organization table with numbers and categories, or table with categories). We evaluated participant knowledge before and after being shown the assigned table.

Results

The most important reason for choosing a contraceptive was how well it works (53%), followed by ease of use (13%), and protection against sexually transmitted disease or human immunodeficiency virus (11%). Before looking at the tables, about half the participants knew that hormone shots are more effective than pills (48%) and that pills are more effective than condoms (57%). For these two key comparisons, the category table compared to the Food and Drug Administration table with numbers improved knowledge significantly more (37% versus 20% and 27% versus 14%; both P < .05). Compared with those assigned to the Food and Drug Administration table with numbers, significantly fewer participants assigned to the category table said the table was difficult to read (6% versus 19%; P < .01). Most participants in all three groups said their assigned table provided enough information to choose a contraceptive method.

Conclusion

The table with categories communicated relative contraceptive effectiveness better than the tables with numbers. However, without being presented with numbers, participants grossly overestimated the absolute risk of pregnancy using contraceptives. A combination of categories and a general range of risk for each category may provide the most accurate understanding of both relative and absolute pregnancy risk.

Section snippets

Materials and methods

We recruited reproductive-age women (18–44 years) at five shopping malls (Matteson, IL; Pembroke Pines, FL; Phoenix, AZ; San Antonio, TX; and Springfield, VA) between August and September 2001. We set recruiting quotas to have the convenience sample reflect the race and education profile of the US population.4, 5 Participants completed self-administered questionnaires that collected demographic information, contraceptive use history, motivational factors for choosing contraceptive methods, and

Results

Our analysis is based on 433 participants (FDA table n = 147; WHO table n = 144; category table n = 142). We excluded six questionnaires from the analysis because the age information was missing and 22 questionnaires because of missing participant identifier information. The participants had a mean age of 26 with an average of 13 years of education (Table 1). The majority (63%) were white, and most (83%) had discussed birth control with a health care provider. A similar proportion (79%) said

Discussion

In our convenience sample, effectiveness was the most important reason for choosing a contraceptive method; this finding is consistent with that of other recent studies.9, 10, 11, 12, 13, 14 Before our intervention, only about half the participants could correctly state which one of two commonly used contraceptives was more effective. The table with general categories of effectiveness communicated relative contraceptive effectiveness better than the tables with numeric estimates of pregnancy

References (18)

There are more references available in the full text version of this article.

Cited by (59)

  • Cognitive interviews to improve a patient-centered contraceptive effectiveness poster

    2018, Contraception
    Citation Excerpt :

    This process is in alignment with CDC and OPA guidelines for developing evidence-based educational materials [2]. Prior work has shown that both written materials and graphical aids can provide effective contraceptive education [3, 4]. This work builds on existing contraceptive posters [24, 25] in being more comprehensible, relevant, and acceptable to women.

  • Impact of Contraceptive Education on Contraceptive Knowledge and Decision Making: A Systematic Review

    2015, American Journal of Preventive Medicine
    Citation Excerpt :

    Our initial database searches identified 17 studies that met the inclusion criteria for this systematic review. Of these, 15 studies20–22,24–27,29–31,33–37 looked at knowledge of correct method use or contraceptive risks and benefits, including side effects and method effectiveness. All but one33 found a statistically significant positive impact of educational interventions.

  • Emergency contraception

    2013, Best Practice and Research: Clinical Endocrinology and Metabolism
View all citing articles on Scopus

Support for this work was provided by the William and Flora Hewlett Foundation.

View full text