Evaluation of a patient-centred, needs-based approach to support shared decision making in contraceptive counselling: the COCO study

Figures & data

Table 1. The COCO study structured decision-making approach.

1	Planned pregnancy Do you have plans to become pregnant? If yes, how soon?	I want to have children in the foreseeable future (next 1–2 years) I do not want children in the next 3–5 years I do not want children in the next few years
2	Importance of no pregnancy How important is it for you not to become pregnant before then?	That is the most important thing for me – a pregnancy would be an enormous burden for me That is very important to me but I know about the failure of contraceptive methods That is relatively important to me but a failure would not be a disaster
3	Satisfaction Are you satisfied with your current contraceptive method?	Yes, I am very satisfied and feel comfortable with it I am somewhat satisfied but perhaps there is or would be another method that suits me better No, I am less satisfied with this method and would like another method of contraception
4	Preference for the frequency of application How important are the following characteristics of a contraceptive method for you?	I would only like to use it when I have sex It doesn’t bother me to regularly apply my method of contraception, that is, daily, weekly or monthly I would like to have to worry about my contraception as little as possible and prefer a method that acts over months or years
5	Application preference How important are the following characteristics of a contraceptive method for you?	I prefer a method for which I am responsible for the contraceptive reliability and that I apply myself I tend towards a method for which I am less responsible, that is, a method that the doctor applies For me, either is OK
6	Desired effect of contraception on periods Which effect on your period would you like most from a contraceptive method?	My period should be less painful, shorter and lighter I should get my period less often (3–4 times per year) or not at all I should still get my period as before or get it regularly each month I should still get my period, but heavier or more painful periods would be unacceptable
7	Attitudes towards hormones What is your attitude to the use of hormones as part of contraception?	Whether with hormones or without – for me the highest priority is the contraceptive reliability I prefer estrogen-free contraception I prefer a low progestogen dose that (largely) preserves ovulation/the natural hormonal cycle I would like hormone-free contraception

Table 2. Use of contraceptive methods by women participating in the structured counselling sessions (N = 1176).

Contraceptive method	n (%)
COC	482 (41.0)
Estrogen-free pill (OI)	41 (3.5)
Estrogen-free pill (mini-pill)	36 (3.1)
Vaginal ring	33 (2.8)
Contraceptive patches	1 (0.1)
Depot injection	8 (0.7)
Implant	7 (0.6)
LNG-IUS	54 (4.6)
Copper IUD	14 (1.2)
Condoms (only)	260 (22.1)
Female barrier methods	6 (0.5)
Natural methods	25 (2.1)
Chemical methods	0 (0.0)
Other contraceptive method	9 (0.8)
No contraception used	200 (17.0)

IUD: intrauterine device; OI: ovulation inhibitor.

Figure 1. Summary of the methods discussed during the consultation, women’s personal preference and the gynaecologist’s recommendation. OI:, ovulation inhibitor.

Figure 2. Impact of the structured counselling approach on considering change of method (immediate post-counselling survey; all women using contraception, n = 790) (*p < .05). IUD: intrauterine device; NFP: natural family planning; OI: ovulation inhibitor.

Table 3. Women’s feedback on the use of the structured counselling approach (n = 951).

Statement	Women’s level of agreement^a
	1	2	3	4	5	6
Overall evaluation of the counselling on the subject of contraception	68	27	4	0.5	0.5	0
The questions about their needs were understandable for the women	80	17	3	0	0	0
The questions about their needs identified the women’s situation well	65	28	6	1	0	0
The discussion document was understandable for the women	73	23	3	1	0	0
The counselling sessions were helpful for the women	71	20	6	2	1	0
The counselling session(s) was/were comprehensive and detailed	71	23	5	1	0	0

Data are presented as % of women.

^a Level of agreement ranged from 1 (very good/completely agree) to 6 (very poor/strongly disagree).

Table 4. Gynaecologists’ feedback on the use of the structured counselling approach (n = 92).

Statement	Gynaecologists’ level of agreement^a
	1	2	3	4	5	6
Overall evaluation of the counselling on the subject of contraception	12	60	22	5	1	0
The questions about their needs were understandable for the women	39	42	13	5	1	0
The questions about their needs identified the women’s situation well	22	50	21	5	1	1
The discussion document was understandable for the women	47	41	10	1	1	0
The counselling sessions were helpful for the women	40	43	12	3	1	1
The counselling session(s) was/were comprehensive and detailed	49	36	11	2	2	0

Data are presented as % of women.

^a Level of agreement ranged from 1 (very good/completely agree) to 6 (very poor/strongly disagree).

Figure 3. Evaluation of contraceptive counselling at 6 months (n = 145).

Table 5. Women’s satisfaction with their contraceptive method.

Contraceptive method	Satisfaction prior to counselling (all women using a contraceptive method, n = 972)			Satisfaction prior to counselling (women using a contraceptive method who participated in the 6 month post-consultation survey, n = 125)^a			Satisfaction at 6 month follow-up (women using a contraceptive method who participated in the 6 month post-consultation survey, n = 128)^b
	Very satisfied	Somewhat satisfied	Not very satisfied	Very satisfied	Somewhat satisfied	Not very satisfied	Very satisfied	Somewhat satisfied	Not very satisfied
LNG-IUS	83	8	9	83	17	0	77	23	0
Contraceptive ring	49	33	18	62	0	38	80	20	0
COC	43	39	18	41	38	21	71	29	0
Estrogen-free pill	27	48	25	11	67	22	48	48	4
Condoms (only)	12	27	61	12	37	51	15	46	39
Overall	35	33	32	33	36	31	65	30	5

Data are presented as % of women.

^a The number of women participating in the 6 month post-consultation survey who were using a contraceptive method and reported their satisfaction with that method prior to their participation in the structured counselling.

^b The number of women participating in the 6 month post-consultation survey who were using a contraceptive method and reported their satisfaction with that method at 6 months.