Contraception and the PICOT Question

Contraception Education for Child-bearing Women Who Speak Primarily Chinese or Cantonese and receive GYN Services at a private OB/GYN Outpatient Clinic
Introduction to the Practice Problem
Contraception use varies between people. Often time there is a link between education and proper contraception use. At the private OB/GYN Outpatient Clinic, women are receiving verbal education on contraception use as there exists no language or culture barrier due to the homogenous nature of the staff and patients. Patients may require additional materials to understand proper contraception use.
Problem Statement
Some contend verbal education of contraception use may not be enough regarding contraception counseling. EBP standardized contraception counseling allows for the use of cue cards and the option of giving a booklet or pamphlet for patients to take home. This is a great means of providing verbal and visual education that will provide further reinforcement of information learned.
Description of Current Practice
The women within the private clinic are educated only verbally. They require additional instructions using visual aids like cue cards and written information like pamphlets and brochures. This ensures that they gain enough information and can retain that information. There are no language barriers or culture barriers within the homogenous population of staff and patients. The main problem is concerning contraception education and retaining said education to make proper contraception choices.
Background and Significance of the Problem
Although the information on contraception may be absorbed verbally, cue cards give visual and written information that can reaffirm the information learned. Educators use visual aids to enable improved learning in students, especially when combined with audio or verbal information. “Audio-visual aids may help to reduce EFL learners' listening test anxiety and enhance their listening comprehension scores without facilitating retention of such materials” (Lee, Lee, Liao, & Wang, 2015, p. 576). Without additional tools for education, contraception use may be faulty at best, leading to potential problems for women who use contraception incorrectly. Things like sexually transmitted diseases and unwanted pregnancies could be an issue.
Therefore, EBP standardized contraception counseling should be implemented for each kind of contraception method to determine if the inclusion of both visual aids and written information like pamphlets and booklets will allow those that require an education, gain improved insight or if these additional materials have no impact, or decrease information learned. This is the basis of the PICOT question and the search strategy.
PICOT Question
The PICOT question is as follow: “In child-bearing women who receive GYN services at an OB/GYN outpatient clinic, how effective is the structured contraception counseling compared to the current individual teaching sessions offered by the healthcare provider in increasing patients’ knowledge of contraception?”
The structured contraception counseling that can be used to educate women in the clinic is: Balanced Counseling Strategy. The main focus will be on the counseling cards to help explain to patients the various methods of contraception and to provide an added opportunity for education and reinforcement of information learned, patients can take home with them, brochures and pamphlets. To test patients’ knowledge on contraception there would be a Contraception Knowledge Assessment (CKA) performed. Several studies have noted CKA to be a useful assessment tool. “The CKA is a valid and reliable tool to measure a patient's level of knowledge regarding contraception. This research tool may allow for the assessment of baseline knowledge, educational gaps, and improvement after an intervention” (Campol Haynes, Saleh, Ryan, Winkel, & Ades, 2015, p. 413). While accuracy of assessment may not be as high as desired, CKA offers an evidence-based, validated, and reliable evaluation of contraceptive information. It is a modern tool aimed at assisting in determining effectiveness of interventions to augment contraception education.
The PICOT question was selected in part because there is no formal way to assess for contraception knowledge and there needs to be a more effective means of educating patients. Using the acknowledge counseling strategy, there is a hope, patients will improve in their contraception knowledge. This may promote less occurrence of unwanted pregnancies and STDs.
Planned Search Strategy
Table A1
PubMed Search Terms and Search Results
Search terms Number of hits
Structured contraception counseling 147
Current individual teaching sessions 909
Contraception Counseling 3886
Contraception Education 9347
Structured contraception counseling and Current individual teaching sessions 2
Structured contraception counseling or Current individual teaching sessions 1054
Contraception Education and Contraception Counseling 1430
Contraception Education or Contraception Counseling 11803
Search range 2009-2017.
Table A2
OvidSP Search Terms and Search Results
Search terms Number of hits
Structured contraception counseling 9559
Current individual teaching sessions 5177
Contraception Counseling 77
Contraception Education 14
Structured contraception counseling and Current individual teaching sessions 9466
Structured contraception counseling or Current individual teaching sessions 9456
Contraception Education and Contraception Counseling 56
Contraception Education or Contraception Counseling 56
Search range 2009-2017.
Results/Search Yield
The aim was to split keywords up that belonged in the PICOT question. For example, “Contraception Education and Contraception Counseling” could be used because the PICOT question involved patient education on contraception and whether contraception counseling was part of the educating the patient. The other identifier, “or” was selected because that way it would yield more search results. Interestingly, for the OvidSP search engine, both phrases produced nearly similar results in terms of number of articles available. The only limitations were that articles could not be before 2009.
The longer search phrases, expectedly produced fewer results. A big difference between PUBMED and OvidSP is that the keyword phrase: “Structured contraception counseling and Current individual teaching sessions” produced two search results compared to 9466 in OvidSP. This could be because of the lack of articles available to PUBMED. PUBMED has the tendency to offer articles within its website whereas OvidSP expands its search pool. The keywords all produced regardless of combination, search results that demonstrated a good number of articles to select from.
Because there are so many articles to select, the daunting task of selecting appropriate articles exist. “The number of journal publications per scientist per year has more than doubled since 1977 (Belefant-Miller & King). In addition to e-journal articles, much scholarly information is available on other web sites and web-based databases and databanks” (Hoggan, 2002). The trick is then to put limits on what should be selected. Because the results were favorable, articles will only be selected that deal with structured contraception counseling and contraception education. These articles also have to be very recent from 2013 and onwards, providing further selection.
Regarding web-based tools and strategies, the commonly used software for citation is EndNote and RefWorks. These two programs allow for seamless storage and integration of references sources (Bramer & Bain, 2017). Although these tools are great for collecting and storing pertinent research information, there are some potential issues with accuracy and other issues. “All programs had problems especially with generating the URL and the date of access in the reference to online documents. It was also found that several mistakes were caused by technical limitations of the reference managers” (Kratochvíl, 2017, p. 57).
Here are some selected articles for the PICOT question that provide a basis of where the search strategy went in relation to methods and how the articles relate to where the direction of the research is. One article discussed the role of contraceptive education (Bader, Kelly, Cheng, & Witt, 2014), and provides the potential basis for a background on how contraception education can impact patient decisions and actions. Another one dealt with contraception education and the potential effects of certain choices (Constance et al., 2014). This could be used to argue against structure contraception counseling or perhaps even go further into contraception education.
The next article discusses the impact of structured counseling on choice of contraception (Chhabra, Mohanty, Mohanty, Thamke, & Deshmukh, 2016). This article can serve as the main means of educating the reader on this kind of contraception counseling. Another article (Sheriar et al., 2014), provides additional information the same subject to serve as a key means of understanding the subject.
















References
Bader, V., Kelly, P. J., Cheng, A., & Witt, J. (2014). The Role of Previous Contraception Education and Moral Judgment in Contraceptive Use. Journal of Midwifery & Women's Health, 59(4), 447-451. doi:10.1111/jmwh.12149
Bramer, W., & Bain, P. (2017). Updating search strategies for systematic reviews using EndNote. Journal of the Medical Library Association, 105(3). doi:10.5195/jmla.2017.183
Campol Haynes, M., Saleh, M., Ryan, N., Winkel, A., & Ades, V. (2015). Contraceptive knowledge assessment: validity and reliability of a novel contraceptive research tool. Contraception, 92(4), 413. doi:10.1016/j.contraception.2015.06.220
Chhabra, H. K., Mohanty, I. R., Mohanty, N. C., Thamke, P., & Deshmukh, Y. A. (2016). Impact of Structured Counseling on Choice of Contraceptive Method Among Postpartum Women. J Obstet Gynaecol India, 66(6), 471-479.
Constance, E., Satterwhite, C., Bi, D., Duarte, M., Gorman, K., & Wieneke, C. (2014). Postpartum contraception education: implications for contraceptive choice and use of long acting reversible contraception (LARC). Fertility and Sterility, 102(3), e142. doi:10.1016/j.fertnstert.2014.07.487
Durante, J., & Woodhams, E. (2015). Patient education about the ACA contraceptive coverage requirement increases interest in long-acting reversible contraceptive use. Contraception, 92(4), 375. doi:10.1016/j.contraception.2015.06.089
Hoggan, D. B. (2002). Challenges, Strategies, and Tools for Research Scientists. Retrieved from http://southernlibrarianship.icaap.org/content/v03n03/Hoggan_d01.htm
Kratochvíl, J. (2017). Comparison of the Accuracy of Bibliographical References Generated for Medical Citation Styles by EndNote, Mendeley, RefWorks and Zotero. The Journal of Academic Librarianship, 43(1), 57-66. doi:10.1016/j.acalib.2016.09.001
Lee, S., Lee, S., Liao, Y., & Wang, A. (2015). Effects of Audio-Visual Aids on Foreign Language Test Anxiety, Reading and Listening Comprehension, and Retention in EFL Learners. Perceptual and Motor Skills, 120(2), 576-590. doi:10.2466/24.pms.120v14x2
Sheriar, N., Joshi, R., Mukherjee, B., Pal, B., Birla, A., & Ray, S. K. (2014). Impact of structured counseling on the selection of hormonal contraceptive methods: results of a multi-centric, observational study in India. J Obstet Gynaecol India, 64(4), 241-50.