Does structured counselling influence combined hormonal contraceptive choice?

Figures & data

Table 1 Gynaecologists’ characteristics.

	n	%	Mean	SD	Median	Range
Total number of gynaecologists who enrolled subjects	121
Gender	119*
Female	67	56
Male	52	44
Age (years)	119*
20–29	0
30–39	41	35
40–49	38	32
50–59	25	21
60 and above	15	13
Consultations for contraception per week on average	118^#		35.1	20.7	30	5–150
Requests for CHC method per week on average	118^#		24.3	13.7	20	1–68
Most frequently recommended contraceptive method	115^$
Combined oral contraceptive	103	90
Vaginal ring	4	4
Levonorgestrel releasing-intrauterine system	6	5
Copper-intrauterine device	1	1
Progestogen-only-pill	1	1
Condoms	0
Transdermal patch	0
Contraceptive implant	0
Natural family planning	0
Injectable	0
Sterilisation	0

*Missing data n = 2.

^#Missing data n = 3.

^$Missing data n = 6; Condoms, patch, contraceptive implant, natural family planning, injectable and sterilisation were never mentioned by the participating gynaecologists as the contraceptive method they most frequently recommended.

Table 2 Log of women consulting for contraception.

	Enrolled in CHOICE?
Reason for contraceptive consult*	Yes 1437 (24%)	No 4367 (74%)	Missing answer 102 (2%)	n 5906
Repeat prescription	497 (35%)	1768 (41%)	35 (34%)	2300
Periodic check	435 (30%)	2360 (54%)	49 (48%)	2844
Problem with current contraceptive	319 (22%)	351 (8%)	9 (9%)	679
Questions about current contraceptive	272 (19%)	304 (7%)	8 (8%)	584
Initiation of contraception or switch to other method	410 (29%)	374 (9%)	12 (12%)	796
Emergency contraception	7 (1%)	36 (1%)	0	43
Other	42 (3%)	459 (11%)	8 (8%)	509

*Multiple answers possible.

Table 3 Patients’ characteristics.

	n	%	Mean	SD
Age (years)*	1800		27.8	6.3
≤ 20	274	15
21–25	442	25
26–30	472	26
31–35	341	19
36–40	271	15
Highest educational level	1796
Primary school	34	2
Secondary school	581	32
Advanced, non university	826	46
University	355	20
Employment status	1769
Unemployed	518	29
Part-time	263	15
Fulltime	988	56
Future desire for children	1792
No	479	27
Yes	1027	57
Do not know yet	286	16
Unplanned pregnancies	1792
No	1638	91
Yes	154	9
1	117	84
2	19	14
>2	3	2
Missing data	15
Steady relationship	1798
No	257	14
Yes	1541	86
Last main contraceptive method	1788
Combined oral contraceptive	1206	67
Vaginal ring	128	7
Condoms	94	5
Progestogen-only-pill	91	5
LNG releasing-intrauterine system	88	5
Never used contraception	72	4
Transdermal patch	39	2
Copper-intrauterine device	35	2
Contraceptive implant	22	1
Natural family planning	11	1
Injectable	2	0

*For one patient the age was not mentioned, nevertheless she was included in the full analysis since missing age was not an exclusion criterion.

Table 4 Cross tabulation of method the woman intended to use before counselling and method chosen after counselling

n = 1799	n (%)	Pill chosen	Patch chosen	Ring chosen	Other method chosen	Not decided yet	Missing data
Patient had no initial preference	199 (11%)	59 (30%)	18 (9%)	63 (32%)	32 (16%)	25 (13%)	2
Patient intended to use pill	1202 (67%)	830 (69%)	52 (4%)	209 (18%)	42 (4%)	63 (5%)	6
Patient intended to use patch	47 (3%)	6 (13%)	20 (44%)	16 (35%)	2 (4%)	2 (4%)	1
Patient intended to use ring	164 (9%)	8 (5%)	0	141 (86%)	14 (9%)	1 (1%)	0
Patient intended to use other method	187 (10%)	38 (20%)	4 (2%)	53 (28%)	71 (38%)	21 (11%)	0
Method chosen	1799	941 (53%)	94 (5%)	482 (27%)	161 (9%)	112 (6%)	9
Figures highlighted in grey: Non-changers
Figures in bold: Method most frequently chosen in relation to the initial preference

Cross tabulation of method which the gynaecologist thought was best for the woman without initial preference and method chosen after counselling
n = 156	n (%)	Pill chosen	Patch chosen	Ring chosen	Other method chosen
Had no initial preference	83 (53%)	35 (42%)	7 (8%)	26 (31%)	15 (18%)
Thought pill was best	12 (8%)	10 (83%)	0	1 (8%)	1 (8%)
Thought patch was best	6 (4%)	1 (17%)	5 (83%)	0	0
Thought ring was best	40 (26%)	4 (10%)	3 (8%)	29 (73%)	4 (10%)
Thought other method was best	15 (10%)	2 (13%)	1 (7%)	1 (7%)	11 (73%)

Figures highlighted in grey: Same method chosen as the one the gynaecologist intended to prescribe

Figures in bold: Method most frequently chosen in relation to the method the gynaecologist thought was best for the patient

Figure 1 Patients’ opinions on contraceptive methods.

Table 5 Summary results of the binomial regression models for prediction of the choice of contraceptive method^#

Table 6 Perception of gynaecologists about the structured counseling (with counselling leaflet) as used in CHOICE

	More	Equal	Less
Did the counselling take more time?	115 (46%)	131 (53%)	2 (1%)
Did you inform her about more contraceptive methods?	93 (38%)	152 (62%)	1 (< 1%)
Did you give the woman more freedom to choose?*	16 (7%)	224 (91%)	3 (1%)
Did you pay more attention to her medical history?	16 (7%)	225 (92%)	2 (1%)
Did you pay more attention to her medical conditions?	12 (5%)	228 (94%)	2 (1%)
Did you pay more attention to possible contra-indications?	11 (5%)	229 (94%)	3 (1%)
Did you pay more attention to special contraceptive needs?	40 (17%)	198 (83%)	1 (< 1%)
	Yes	No
Did you have a more open discussion?	37 (15%)	203 (85%)
Did the counselling process uncover factors that made you change your precounselling opinion?	210 (14%)	34 (86%)
Was the counselling more useful for the women?	132 (54%)	111 (46%)
Was the counselling more useful for the gynaecologist?	27 (11%)	216 (89%)
Was the counselling more time-consuming?	133 (54%)	112 (46%)
Was the counselling leaflet complete?**	207 (86%)	29 (12%)

*1% of answers missing.

**2% of answers missing.