Effects of structured contraceptive counseling in young women: Secondary analyses of a cluster randomized controlled trial (the LOWE trial)

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica Pub Date : 2024-09-26 DOI:10.1111/aogs.14954

Karin Emtell Iwarsson, Volodymyr Podolskyi, Isabella Bizjak, Helena Kopp Kallner, Kristina Gemzell-Danielsson, Niklas Envall

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Abstract

Introduction

Unwanted pregnancy constitutes a huge health issue. Long-acting reversible contraception (LARC) are the most effective methods for preventing unwanted pregnancy, especially among young women. This study evaluates the intervention effect of structured contraceptive counseling on the choice, initiation, and use of LARC in young women.

Material and Methods

This is a secondary analysis of women aged 18–25, enrolled in a multicenter cluster randomized controlled trial performed in abortion, youth, and maternal health clinics across the Stockholm County in Sweden. Clinics were randomized (1:1) to provide structured contraceptive counseling (intervention) or standard counseling (control). Surveys were administered at the clinic visit and follow-ups at 3, 6, and 12 months. Primary outcome focused on the choice of LARC among women 18–25 years of age. Secondary outcomes included initiation, and use of LARC at 3 and 12 months, satisfaction with the counseling received and information on extended use of combined hormonal contraceptives. The study was registered at Clinicaltrials.gov (NCT03269357).

Results

From September 2017 to May 2019, 770 women aged 18–25 years from 28 clinics/clusters were recruited. There was a significant intervention effect on LARC choice (aOR 5.96, 95% CI 3.25–10.94), initiation (aOR 4.43, 95% CI 2.32–8.46), and use at 12 months (aOR 2.21, 95% CI 1.31–3.73). The odds of LARC choice at pre-booked visits were higher and more women received information about extended-use regimen for short-acting reversible contraception in the intervention group compared to the control group. The intervention package was well received, but with higher satisfaction at pre-booked compared to drop-in visits.

Conclusions

Our study demonstrates that comprehensive structured contraceptive counseling significantly increases LARC choice, initiation and use, with high satisfaction among young participants, especially at pre-booked visits. The results highlight an approach that merits implementation to increase quality of care in contraceptive services, to enhance reproductive health for adolescents and young adults.

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结构化避孕咨询对年轻女性的影响：分组随机对照试验（LOWE 试验）的二次分析。

导言意外怀孕是一个巨大的健康问题。长效可逆避孕药（LARC）是预防意外怀孕最有效的方法，尤其是在年轻女性中。本研究评估了结构化避孕咨询对年轻女性选择、开始和使用 LARC 的干预效果：本研究对瑞典斯德哥尔摩县的人工流产、青年和孕产妇保健诊所中参加多中心群组随机对照试验的 18-25 岁女性进行了二次分析。诊所被随机（1:1）安排提供结构化避孕咨询（干预）或标准咨询（对照）。在门诊就诊以及 3、6 和 12 个月的随访期间进行调查。主要结果侧重于 18-25 岁女性对 LARC 的选择。次要结果包括 LARC 的开始使用情况、3 个月和 12 个月的使用情况、对所接受咨询的满意度以及有关延长联合荷尔蒙避孕药使用期限的信息。该研究已在Clinicaltrials.gov（NCT03269357）上注册：2017年9月至2019年5月，共招募了来自28个诊所/群组的770名18-25岁女性。干预对 LARC 选择（aOR 5.96，95% CI 3.25-10.94）、启动（aOR 4.43，95% CI 2.32-8.46）和 12 个月的使用（aOR 2.21，95% CI 1.31-3.73）均有显着影响。与对照组相比，干预组妇女在预约前就诊时选择 LARC 的几率更高，获得短效可逆避孕药延长使用方案信息的人数也更多。干预方案受到了广泛欢迎，但与上门服务相比，提前预约的满意度更高：我们的研究表明，全面的结构化避孕咨询可显著提高 LARC 的选择、启动和使用率，年轻参与者的满意度也很高，尤其是在预约前就诊时。研究结果凸显了一种值得实施的方法，它能提高避孕服务的质量，改善青少年和年轻成年人的生殖健康。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Obstetricia et Gynecologica Scandinavica 医学-妇产科学

CiteScore

8.00

自引率

4.70%

发文量

180

审稿时长

3-6 weeks

期刊介绍： Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.