Supporting informed decisions about tubal sterilization with a patient-facing website: a randomized trial.

Abstract

Background: Interest in permanent contraception has increased in the US since the 2022 Dobbs decision restricted access to abortion in many states. Despite use of the federally mandated "consent for sterilization" form HHS-687, one of every five US patients who undergo tubal sterilization subsequently reports a desire to reverse their tubal sterilization, indicating that efforts to ensure informed decision-making before permanent contraceptive procedures remain needed.

Objectives: To increase access to desired contraceptive services and knowledge of long-acting contraceptive options, we developed and evaluated the efficacy of a patient-facing educational website for patients considering tubal sterilization.

Study design: We enrolled 350 individuals considering tubal sterilization in a randomized controlled trial. Participants allocated to the intervention group reviewed the "Advancing Access" website while the "attention control" group reviewed the federal sterilization consent form HHS-687 and Planned Parenthood's tubal sterilization website. Follow-up data was collected within 1 week and 3 months following the website review. The study's primary outcome was a multidimensional measure of access to reproductive health services measured 3 months after website review that assessed awareness, availability, affordability, acceptability, and belief that a given method of birth control was safe given their personal health status, with attention to 6 methods (tubal sterilization, vasectomy, IUD, implant, emergency contraception, and abortion pills). Secondary outcomes included contraceptive knowledge and preferences. We used Chi-square and t-tests to compare study groups, and multivariable linear regression models to assess the robustness of the intervention effects, after controlling for participant age, education, race/ethnicity, marital status, history of pregnancy, and region of residence.

Results: The average age of the 350 study participants was 33 +/- 7 years. Most (55%, 192/350) had publicly funded health insurance, and 67% (237/350) had annual household incomes below $60,001. On enrollment, average perceived access (52% vs 53%, p=0.46) and average contraceptive knowledge scores (42% vs 41% of questions answered correctly, p=0.67) were similarly low in both study groups. Three months after enrollment, the intervention group had greater perceived access to birth control (62% vs 58%, p=0.02; adjusted mean difference 3.24, 95% CI: 1.81-4.67). Within 1 week of reviewing the study materials, the intervention group showed significantly greater improvement in average contraceptive knowledge scores (68% vs 52% of questions answered correctly, P<0.001) that persisted at 3 months (61% vs 52%, p < 0.001; adjusted mean difference 2.00, 95% CI: 0.21-3.79). At 3-months, tubal sterilization remained the most commonly preferred method in both study groups (30% intervention vs 25% control, p=0.40), with increased preference for implant use (17% vs 9%, p=0.05) in the intervention group at 3 months.

Conclusions: The "Advancing Access" website increases perceived access to and knowledge of long-acting contraceptives more than the federal sterilization consent form, even when combined with review of another website.