mHealth technologies for pregnancy prevention: A challenge for patient-centred contraceptive counselling in Dutch general practice

Abstract

Background

A general practitioner (GP) standardly provides contraceptive counselling and care in the Netherlands. Recent years have seen the rise of mobile health technologies that aim to prevent pregnancy based on fertility awareness-based methods (FABMs). We lack high-quality evidence of these methods’ effectiveness and clarity on how healthcare professionals include them in contraceptive counselling.

Objectives

To analyse how Dutch healthcare professionals include pregnancy-prevention mobile health technologies (mHealth contraception) in contraceptive counselling and to propose practice recommendations based on our findings.

Methods

We used ethnographic methods, including semi-structured interviews with nine professionals who were recruited using purposive sampling, 10 observations of contraceptive counselling by four professionals, six observations of teaching sessions in medical training on contraception and reproductive health, one national clinical guideline, and seven Dutch patient decision aids. Data were collected between 2018 and 2021 and analysed inductively using praxiographic and thematic analysis.

Results

In contraceptive counselling and care, professionals tended to blend two approaches: 1) individual patient-tailored treatment and 2) risk minimisation. When interviewed about mHealth contraception, most professionals prioritised risk minimisation and forewent tailored treatment. Some did not consider mHealth contraception or FABMs as contraceptives or deemed them inferior methods.

Conclusion

To minimise risk of unintended pregnancy, professionals hesitated to include mHealth contraception or other FABMs in contraceptive consultations. This may hamper adequate patient-centred counselling for patients with preference for mHealth contraception.

Based on these results, we proposed recommendations that foster a patient-tailored approach to mHealth contraceptives.

ABSTRACT

KEY MESSAGES

• Prioritisation of risk minimisation precluded professionals from including FABMs and mHealth contraception in their counselling.

• For patient-centred counselling, professionals need differentiated information about FABM use and effectiveness through adequate guidelines and training.

Keywords:

• Contraceptive counselling
• non-hormonal contraception
• mHealth technologies
• risk minimisation
• patient-centred care

Acknowledgements

This article would not have been possible without participation of healthcare professionals, practice assistants and educators. We thank those who participated for their time and effort. We thank the patients who allowed us to observe their consultations for their courage and willingness. We thank the reviewers and editors of this journal for their invaluable feedback to improve the manuscript in various version. Thank you Mirjam Dijkxhoorn, Karina Hof and Machiel Keestra for your inspiring input and support in improving the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).