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Ruth Petersen, MD, MPH UNC Center for Women’s Health Research

Contraceptive Counseling Using an Adaptation of Motivational Interviewing: Results from a Randomized Trial. Ruth Petersen, MD, MPH UNC Center for Women’s Health Research University of North Carolina at Chapel Hill. Background.

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Ruth Petersen, MD, MPH UNC Center for Women’s Health Research

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  1. Contraceptive Counseling Using an Adaptation of Motivational Interviewing: Results from a Randomized Trial Ruth Petersen, MD, MPH UNC Center for Women’s Health Research University of North Carolina at Chapel Hill

  2. Background • Providers are in a unique position to address women’s contraceptive needs • Many providers do not do so- often because of complexity of issues or time restraints • We lack a standardized and proven intervention for provision of contraceptive counseling in clinical setting

  3. Objectives • To evaluate Women’s Reproductive Assessment Program (WRAP), a behavioral-based, contraceptive counseling intervention administered by health educators

  4. WRAP Intervention • Individualized counseling regarding effectiveness and consistency of contraceptive use and/or reduction in sexual risk-taking: • Modification of motivational interviewing (MI) • Address barriers to changing behavior • Conclude with negotiation of risk reduction steps

  5. ESP model • Application of MI to contraceptive counseling through ESP • Exploring discrepancies between pregnancy intention and contraceptive use and between risk of STIs and condom use • Sharing information • Promoting behaviors to reduce risk Petersen, Payne, Albright, Holland, Cabral, Curtis. Contraception 2004;69:213-217.

  6. Steps in WRAP Study Intervention Control Baseline Survey & Contraceptive Counseling Baseline Survey 2 month survey 2 month survey & booster 8 month survey 8 month survey 12 month survey 12 month survey

  7. 4,101 women screened 1,330 refused screen/enroll 737 enrolled 365 I; 372 C 2,034 not eligible Enrollment From 3/03 to 9/05 at 3 healthcare sites

  8. Participant Characteristics • Age 16-25 41% 26-44 59% • Race/ethnicity White 62% African-American 27% Latina 3% • Sexually active (last 30 days) Yes 70%

  9. Pregnancy Attitude • Do not want to be pregnant in near future 64% • Does not want to ever be pregnant 15% • Doesn’t know whether wants to be pregnant or not 21%

  10. Contraceptive Use at Baseline(Any Use) All participantsSexually active (n=737) (n= 517) • Oral contraceptives 37% 42% • Condoms 36% 49% • No method 22% 5% • IUD, Depo, Norplant 12% 13% • Patch, Nuva-Ring 6% 7% • Diaphragms, spermicide 3% 4%

  11. Effectiveness of Contraceptive Use *Takes into account effectiveness of primary method and consistency with which the method is used

  12. Proportion of Women With Highly Effective Use or Improvement in Contraceptive Effectiveness Baseline: p=0.82 2 mo: p=0.09 8 mo: p=0.78 12 mo: p=0.29

  13. Method of Questionnaire Response 12-Month Enrollment 8-Month 2-Month

  14. Conclusions • Many women receiving primary care are at risk of unintended pregnancy due to lack of effectiveness of contraceptive use • Repeated counseling is needed to address women’s pregnancy intention and effectiveness of contraceptive use

  15. Acknowledgments • Centers for Disease Control and Prevention (CDC) • Association for Teachers of Preventive Medicine (ATPM)

  16. Questions?

  17. Extra information Only to be used if needed for discussion

  18. Motivational Interviewing (MI) • Helps clients recognize and change behaviors that put health at risk • Emphasizes development of self-efficacy • Addresses specific needs and barriers • Counselor has a clear goal yet process is client-centered

  19. Risk Reduction Steps Chosen & Completion Rates at 2 Months (n=365) # chose (2-mo completion) • Continue current method 214 (90%) • Increase consistency of method 37 (68%) • Start or re-start method 91 (75%) • Medical follow-up 59 (46%) • Think or talk about starting method 132 (80%)

  20. Consistency of Contraceptive UseAny use; among sexually active; % users who use consistently • Patch or Nuva-Ring 94% • Oral contraceptives 82% • Condoms 56% • Diaphragm, spermicide 33% • Other 50%

  21. Enrollment Acceptance of EC and 2-month follow-up • Enrollment (among 336 women) • Accepted script 172 (51%) • Declined script 125 (37%) • Other (no discussion or missing) 39 (12%) • 2-month follow-up (among 158- accepted and complete data) • Filled and used 10 (6%) • Filled and not used 13 (8%) • Not filled 135 (86%)

  22. Method of Questionnaire Response Intervention Control Total • Baseline • Paper 365 372 737 • 2-month • Paper 301 162 463 • Web 16 169 185 • 8-month • Paper 176 189 365 • Web 167 160 327 • 12-month • Paper 288 302 590 • Web 41 33 74

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