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Counselling of adolescent women on contraceptive methods

Counselling of adolescent women on contraceptive methods. Educational Slide Kit Module 3: Essentials for counselling adolescents about contraception. Module content. Importance of healthcare providers as a source of contraceptive advice

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Counselling of adolescent women on contraceptive methods

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  1. Counselling of adolescent women on contraceptive methods Educational Slide Kit Module 3: Essentials for counselling adolescents about contraception

  2. Module content Importance of healthcare providers as a source of contraceptive advice Key elements of best practice when counselling adolescents Using a structured interview approach Using the CARE Counselling Checklist as a supportive tool Creating a positive experience for adolescent women seeking contraceptive advice

  3. Healthcare providers are a trusted source of contraceptive advice for adolescent women1,2 • Maintain skills in the counselling of all methods • Address common myths and misperceptions that may inappropriately limit their recommendations or adolescent choice 1. Black AY, et al. Poster presented at SOGC, 2013; 2. Bitzer J, et al, 2016. Eur J ContraceptReprod Health Care 2016;21:6,417-430 • Healthcare providers are ideally placed to guide adolescent women in their decision about contraception2 • Therefore, it is important that they:2 • Tailor their counselling approach

  4. Essentials for the contraceptive counsellingof adolescent women: Sharing knowledge • 1. Bitzer J, et al. Eur J ContraceptReprod Health Care 2016;21:6,417-430 • As experts in sexual and reproductive health, the global CARE group identified key elements of best practice when counselling adolescents about contraception1 • Sharing knowledge should aim to:1 • explore feelings and expectations around contraception • help a young woman to choose a method of contraception that best fits her needs and personal beliefs

  5. Using a structured approach can help to create a positive counselling experience • Greet • Ask • Tell • Help • Explain • Reassure • 1. Rinehart W, et al. GATHER Guide to Counseling. Population Reports 1998, Series J, No. 48. The global CARE group used the GATHER1approach as the basis for creation of a checklist to help create a positive experience when counselling adolescents

  6. Essentials for the contraceptive counsellingof adolescent women: Five key steps 1 2 3 4 5 Are you welcoming? What to ask Have you checked? What to tell Have you reassured her?

  7. Are you welcoming? 1 • Informing her that a pelvic exam is not needed to start or continue most methods of contraception • Creating an open and empathetic environment Acknowledging her need for confidentiality and privacy (e.g. being able to ask an accompanying person to wait outside) Recognizing the need for a different approach (and language) for adolescent women versus women in their twenties and thirties

  8. What to ask 2 Her reproductive and sexual history, including previous and current use of contraception Her medical history, including any specific conditions and medication Her current relationships, partners and whether she has any concerns Her needs and expectations from a contraceptive method Her ability and motivation to use contraception regularly and correctly Her thoughts on using an injectable or long-acting reversible method The level of support she has at home, from the community and/or partner Whether she needs to hide her use of contraception

  9. Motivational Interviewing techniques can be used successfully in a contraceptive counselling situation1 Using OARS2 Open-ended questions Affirmations Reflective listening Summaries • 1. Lopez LM et al. Theory-based interventions for contraception. Cochrane Database Syst Rev. 2016 Nov 23;11:CD007249; 2. Miller WR, Rollnick S. Motivational interviewing: Preparing people for change. 1991; New York: Guilford Press. • Four guiding principles in motivational interviewing2 • Express empathy – seek to understand feelings and perspectives without judging • Develop discrepancy – create or amplify the discrepancy between current behaviour and broader goals and values • Roll with resistance – new perspectives are invited but not imposed and resistance is reframed to create a new momentum toward change • Support self-efficacy – use belief in the possibility of change as a motivator

  10. Asking the right questions, in the right way • Motivational interviewing (MI) techniques can be useful to:1-3 • 1. Miller WR, Rollnick S. Motivational interviewing: Preparing people for change. 1991; New York: Guilford Press; 2. Ott MA, Sucato GS. Pediatrics 2014;134(4):e1257–81; 3. ACOG Committee Opinion No. 423. Obstet Gynecol 2009;113(1):243–6. • Explore and manage ambivalence towards pregnancy and contraception • Identify inconsistencies between life goals and sexual behaviour • Anticipate potential compliance or adherence issues • Assist in the selection of the most appropriate method

  11. Fear of a pelvic exam can be a barrier to adolescents when seeking contraception1,2 1. Harper C, et al. Fam Plann Perspect 2001;33:13–8; 2.Henderson JT, et al. Obstet Gynecol 2010;116(6):1257–64; 3. World Health Organization. Selected practice recommendations for contraceptive use. 2nd ed. Geneva: WHO; 2004; 4. ACOG Practice Bulletin No. 140, Obstet Gynecol 2013;122(6):1338-67; 5. Committee on Adolescent Health Care. Obstet Gynecol. 2017 May;129(5):e142-e149; 6. World Health Organization. Medical eligibility criteria for contraceptive use. 5th ed. Geneva: WHO; 2015. • One third of ob-gyns and family physicians require a pelvic exam prior to initiation of contraception despite being aware of guidelines indicating they are unnecessary2 • Neither pelvic exam nor cervical cancer screening are needed to start or continue most methods of contraception3-5 • Those patients requesting intrauterine contraception (IUC) should be counselled regarding the requirement for a pelvic examination5,6

  12. A contraceptive consultation provides an opportunity to discuss STI risk Rate (per 1000,000 population) Men Women Age 4000 3200 2400 1600 800 800 1600 2400 3200 4000 0 0 10-14 14.7 108.9 15-19 715.2 3043.3 20-24 1325.6 3621.1 25-29 757.9 1428.3 30-34 390.9 599.2 35-39 207.5 273.4 40-44 116.6 118.3 45-54 55.9 41.4 55-64 17.0 11.3 65+ 4.0 2.5 Total 262.6 623.1 Rates of reported cases of chlamydia by age and sex, United States, 2013 1. Murray PJ, et al. Pediatrics 2014;134:e302–e311; 2. Centers for Disease Control and Prevention. (2014, December). Accessed at:http://www.cdc.gov/std/stats13/surv2013-print.pdf. Prevalence rates of many sexually transmitted infections (STIs) are highest among adolescents1,2 Women aged <25 years have the highest rates of chlamydia1

  13. Screening for STIs when counselling adolescents1,2 • 1. USPSTF. Accessed at: http://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-recommendations-for-sti-screening; 2. Hoopes AJ et al. J PediatrAdolesc Gynecol. 2017 Apr;30(2):149-155; 3.Ott MA, Sucato GS and Committee on Adolescence. Pediatrics 2014;134(4):e1257–1281. • Screening for chlamydia and gonorrhoea can be performed by nucleic acid amplification test (NAATs) of urine or cervical/vaginal swabs1 • Starting hormonal contraception is not dependent on the results of an STI screening test1-3 • It is reasonable and possible to screen for an STI and initiate contraception on the same day2 • Treatment can then be provided if the test results are positive3

  14. Have you checked? 3 Her awareness of methods and whether she already has a preference The accuracy of her knowledge, including her fears and concerns Methods matching her needs and expectations have been discussed The identified potential options are acceptable to her If cost is an issue – how she will pay for contraception Whether STI screening is appropriate If you think she is ready to make a decision, help her make an informed choice that matches her contraceptive needs and expectations as well as her lifestyle

  15. In principle, all methods of contraception are an option for adolescent women • The WHO Medical Eligible Criteria1 say that • ‘no medical reason currently exists to deny any method based on young age alone’ • 1. World Health Organization. Medical eligibility criteria for contraceptive use. 5th ed. Geneva: WHO; 2015

  16. Teenage knowledge and awareness of methods is lower than that of young adult women1 1. Craig AD, et al. Women Health Issues 2014;24(3):e281–9. * Depot contraception

  17. You can use the reverse of the Counselling Checklist to further discuss choice of contraceptive method

  18. What to tell 4 • What the non-contraceptive benefits are (if relevant) • When to return for a follow-up appointment How the method works, how effective it is, how to take it correctly and consistently, and when to start How it will affect her menstrual cycle What the potential side effects are and what to do if they occur

  19. Many women are unaware of the therapeutic uses of hormonal contraceptives 1. Lakehomer H, et al. Contraception 2013;88(3):426-430; 2. Burkman R, et al. Am J Obstet Gynecol 2004;190(4 Suppl):S5-22; 3. ESHRE Capri Workshop Group. Hum Reprod Update 2005;11(5):513-525; 4. Schindler AE. Int J Endocrinol Metab 2013;11(1):41-47; 5. Vessey M, Yeates D. Contraception 2013;88(6):678-683; 6. ACOG practice bulletin no. 110: noncontraceptive uses of hormonal contraceptives. Obstet Gynecol 2010;115(1):20. • Some combined hormonal methods are known to exert beneficial effects on aspects related to menstruation1-4 • Lighter bleeding, more regular and stable menstrual cycles • Reduction in dysmenorrhea (painful menstruation) • They can also reduce the risk of endometrial and ovarian cancer5and improve acne symptoms6

  20. Have you reassured her? 5 • She has taken the first step to an empowered, healthy, and safer sexual life • And checked whether she has any remaining fears or concerns about her contraception? For the majority of healthy young women, the benefits of modern contraceptive methods outweigh the risks That correct and continuous use is essential for best results and she should not stop her contraceptive method without first contacting a healthcare provider unless in an emergency

  21. Regular follow-up can help address any issues with compliance • Regardless of the method chosen, scheduling follow-up appointments:1,2 • Creates an opportunity to discuss satisfaction with method and change if needed1 • Provides reassurance around potential short-term side effects2 • Improves contraceptive compliance1 • Allows screening for STIs1 1. Yoost JL et al. J Adolesc Health. 2014;55(2):222–7; 2. Grossman N. Am Fam Physician. 2010;82(12):1499-1506

  22. Conclusions • Choose a method of contraception that best fits your patient’s needs and personal beliefs • Creating a positive experience during a medical consultation for contraception is a powerful opportunity to:1 • Provide accurate sexual and reproductive health information • Address and correct misperceptions • 1. Bitzer J, et al. Eur J ContraceptReprod Health Care 2016;21:6,417-430

  23. CARE materials are available to download from www.your-life.com Checklist 4x patient cases Publication 2 animated videos 3x slide modules

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