Ways to Improve Contraception Counseling

Proper contraception usage is one of the most important factors towards improving patient outcomes in the obstetrics and gynecology setting. The search of evidence in existing literature has demonstrated that contraception use differs among patient populations while there is a strong link between education and proper contraception use (Gosavi et al., 2016). The existing evidence has also shown that healthcare providers in the obstetrics and gynecology setting utilize various teaching tools to provide education to patients on contraception use. The teaching tools range from verbal education to visual education like cue cards and pamphlets for patients to take home and further reinforce information communicated in the clinic (Lee, 2014). However, there is need for additional materials and strategies for patients to understand proper contraception use. In essence, while the use of various teaching tools helps in enhancing patients’ knowledge, proper contraception usage requires the use of better strategies. Such strategies would help in meeting the need for additional materials and methods to promote proper usage of contraception.

Strategies to Move Evidence-based Recommendations into Practice
The search for literature has provided evidence-based recommendations that should be moved into clinical practice in order to promote proper contraception use among patients in the obstetrics and gynecology setting. According to a publication by Australia’s National Health and Medical Research Council (2000), there are various implementation and dissemination strategies for putting evidence-based recommendations into clinical practice. These strategies include conducting educational outreach visits, multifaceted interventions, mass media campaigns, interactive educational meetings, and administrative interventions. These implementation and dissemination strategies are utilized through formulating a program that focuses on promoting the use of evidence-based recommendations in clinical practice.
For this study, the researcher will develop a program that seeks to enhance patients’ knowledge on contraception usage. This program will be centered on multifaceted interventions, which are needed to promote the use of research evidence in administrative and clinical decision making in different healthcare settings (Titler, 2008). The program will be developed and implemented as a project in an outpatient obstetric and gynecology clinic. The use of an outpatient clinic for this project provides a suitable environment for promoting enhanced contraception knowledge and usage within and outside the hospital. The project will be designed as a multifaceted intervention strategy since such a strategy has been found to be more effective in the clinical setting than single intervention strategies. Grimshaw et al. (2006) contends that multifaceted interventions are more effective than single interventions with respect to moving evidence-based recommendations into clinical practice. This is primarily because multifaceted interventions address clinical practice based on the individual practitioner, patient population, and organizational perspective.
The project, which will provide the basis for translating evidence-based recommendations into practice, will be carried out through a series of steps. The first step will entail selecting a practice topic, which is usually the first step in translating evidence-based research into clinical practice (Titler, 2008). This step was carried out in the first parts of this assignment in which the researcher identified the issue of contraception usage among Chinese/Cantonese-speaking women in outpatient obstetric and gynecology clinic. This is followed by evaluating and synthesizing existing evidence on the research issue, which was also carried out in the previous segments of this DNP project. The third step will involve designing a program/project that focuses on using evidence-based recommendations to guide clinical practice. The project will primarily focus on determining the effectiveness of The Balanced Counseling Strategy in enhancing contraception knowledge among this patient population as compared to routine contraception counseling. Therefore, the researcher will utilize two interventions in the study i.e. The Balanced Counseling Strategy and routine counseling strategy. Once the project is implemented, it will be evaluated in terms of the impact of evidence-based recommendations on clinical practice. This evaluation will focus on examining how the project affects provider performance as well as patient care and outcomes. The evaluation will also involve assessment of the setting or context in which this clinical practice was implemented.
The use of these various steps as part of the multifaceted intervention strategy for translating evidence-based recommendations into clinical practice is attributable to the fact that they promote learning in each stage of the process. Titler (2008) states that the learning that takes place in each of these steps and process provide valuable insights for capturing and providing feedback into the process. These valuable insights are captured to help other clinicians in relatively similar settings to adapt the evidence-based recommendations and/or implementation strategies in their clinical practice. This essentially means that the project will act as a foundation through which clinicians in other settings could adapt evidence-based recommendations and/or the implementation strategies to transform clinical practice.
This pilot project could then be utilized as the premise for administrative interventions, which is also a strategy that can be utilized to move evidence-based recommendations into practice. Administrative interventions basically entail healthcare decision making to change clinical practice (National Health and Medical Research Council, 2000). In this regard, necessary administrative steps are undertaken including removing barriers to implementation of evidence-based recommendations and promoting change in behavior among clinicians to support the process. These interventions will act as a premise for ensuring continuity in the translation of evidence-based recommendations into clinical practice. Through this process, the validity of decisions made earlier is considered and the need for any further changes is identified and implemented to support evidence-based practice (Kulier, Gee & Khan, 2008).
Changing Clinical Practice
This project will focus on promoting changes in clinical practice in order to enhance contraception use among Chinese/Cantonese-speaking women in an obstetric and gynecology outpatient setting. Based on the insights obtained from evaluation of existing evidence, the researcher will develop a project that seeks to promote changes in contraception education in the clinical setting. Through this project, the researcher seeks to identify the most effective method for improving patients’ knowledge and use of contraception. The identification of the most effective educational strategy will help in changing clinical practice with respect to patients’ contraception knowledge and use. The identified method for enhancing patients’ knowledge and use of contraception will be based on evidence-based recommendations.
In this regard, the researcher will conduct a quantitative pre-test, posttest study that will examine the effectiveness of structured contraception counseling in improving patients’ knowledge and use of contraception in comparison to routine contraception counseling. Therefore, structured contraception counseling is the main concept of interest in this project since the current routine contraception counseling is relatively ineffective in enhancing patients’ knowledge and use of contraception. The quantitative pre-test, posttest study will be conducted on a group of child-bearing women who speak Chinese or Cantonese and receive gynecological services at a private obstetrics/gynecology outpatient clinic. The researcher has identified a private Obstetrics and Gynecology (OB/GYN) outpatient clinic that is an ideal setting for the project. This private clinic currently utilizes routine contraception counseling in which child bearing women at the facility receive verbal education on contraception use and are also given pamphlets and cue cards as visual education tools to be used at home. While there are no language or cultural barriers within this homogenous population of staff and patients, patients experience difficulties in retaining what they learn from the contraception education tools.
When conducting this study, The Balanced Counseling Strategy (BCS) will be utilized as the structured contraception counseling. The BCS toolkit incorporates international family planning norms and guidance as recommended by the World Health Organization (WHO), including the 2004 Medical Eligibility Criteria for Contraceptive Use and the 2007 Family Planning Global Handbook (Population Council, 2007). 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 reinforcement of information. Patients can take the brochures and pamphlets home with them.
The use of a quantitative pretest-posttest research design for this project is attributable to the fact that this research methodology is suitable when comparing groups and/or measuring changes emanating from experimental treatments (Dimitrov & Rumhill, 2003). Allesandri, Zuffiano & Perinelli (2017) state that a pretest-posttest research design is appropriate for evaluating the effectiveness of intervention programs utilized in the clinical setting. Since this research seeks to examine the effectiveness of BCS as a structured contraception counseling vis-à-vis routine methods, a pretest-posttest research design is the most suitable research methodology for the project.
When conducting the project, the researcher will divide the participants into two groups i.e. an experimental group and a control group. This implies that a two groups, pretest-posttest research approach will be utilized in this project. The participants will be randomly selected and assigned to these groups. The experimental group will be exposed to the experimental treatment i.e. The Balanced Counseling Strategy while the control group will only be subjected to routine contraception counseling. At the beginning of the study, the researcher will collect baseline or pretest data for each group with respect to contraception knowledge and usage. Upon completion of the study, the researcher will collect posttest data to help determine which counseling strategy enhanced contraception knowledge and usage among the research participants. The posttest data collected from the experimental group i.e. those subjected to structured contraception strategy (BCS) will be compared to the posttest data obtained from the control group that did not receive the experimental treatment and were only subjected to routine contraception counseling.
Contraception Knowledge Assessment (CKA) will be utilized to collect posttest data from the experimental group and control group to determine if there is an increase in patients’ knowledge of contraception. 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 et al., 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. Data obtained from the Contraception Knowledge Assessment will be analyzed statistically to help in determining the most effective method for increased contraception knowledge and usage among child-bearing women.
Conceptual Framework
This project will be guided by a theoretical framework or model since the explicit utilization of theory in research plays a critical role in expanding the knowledge base (Lopez et al., 2009). The use of a theoretical framework to support this study is attributable to the fact that the relevant theories will act as the scientific underpinning for the research. In this regard, the researcher has identified several theories and model including the Health Belief Model, Social Cognitive Theory, and the Theory of Reasoned Action and Planned Behavior.
Social Cognitive Theory will be utilized as the basis for designing and implementing the experimental treatment i.e. The Balanced Counseling Strategy for the experimental group. Social Cognitive Theory is suitable for this study since it focuses on the process through which people learn to embrace new behaviors (The WHO Reproductive Health Library, 2012). This theory also focuses on understanding the risks and benefits associated with behavior change, development of self-efficacy, and evaluation of outcome expectations due to behavior change. Social Cognitive Theory provides a foundation for behavioral intervention towards enhancing health outcomes relating to knowledge and use of contraception among child-bearing women. Okonofua (2014) states that Social Cognitive Theory has been utilized to examine several reproductive behavioral changes including use of contraception. The goal of this project is to identify the most suitable method for child-bearing women to enhance their knowledge and usage of contraception. Social Cognitive Theory relates to this objective in the sense that enhanced contraception knowledge and usage among child-bearing women is tantamount to development of self-efficacy, which is a crucial component of this theory.
The Health Belief Model is a social-cognitive framework that will be utilized in this project or study. According to Hall (2012), this model is suitable for explaining and influencing contraceptive behavior. A critical aspect of the implementation of this project is the identification of the most suitable educational strategy to enhance contraception knowledge among child bearing women and influence their contraceptive behavior. The Health Belief Model provides a suitable foundation through which the researcher will develop interventions to help improve contraception knowledge and usage. This model views humans as rational beings who utilize multifaceted approaches to decision-making on carrying out a health behavior. As a result, this model can be utilized to evaluate the effect of new and enhanced contraceptive methods on behavior. With regards to this study, the Health Belief Model will be the premise for development of the structured contraception counseling. The researcher will also utilize this method in designing the Contraception Knowledge Assessment for examining the impact of the interventions on enhancing contraception knowledge among research participants. Therefore, the evaluation of posttest data obtained during this study will be based on concepts of the Health Belief Model.
The third theoretical framework that will support this study is the Theory of Reasoned Action and Planned Behavior. This theoretical framework incorporates comprehensive theories of many behaviors that suggest that behavior is influenced by a small number of psychological variables including intention, attitude towards the behavior, perceived behavior control, and subjective norm (Albarracin, 2001). This theory suggests that intentions to engage in a particular behavior are usually affected by an individual’s attitudes towards that behavior and perceptions of its associated norms (Sable et al., 2006). For this study, this theory will be utilized to influence the perceptions of child-bearing women towards enhanced contraception knowledge and use. In this regard, the researcher will educate the participants regarding the potential benefits of enhanced contraception knowledge prior to the commencement of the project. This will be carried out based on the belief that understanding of the potential benefits of improved contraception knowledge will enhance the intentions and attitudes of the participants to engage in this project. The enhanced intentions and attitudes to participate in the project will in turn provide a suitable framework for obtaining rich data on the research issue. The researcher believes that knowledge regarding potential benefits of enhanced contraception knowledge will influence the participants’ intentions to engage in the project. Moreover, this will help enhance changes in contraceptive behavior among child-bearing women.
Translational Research and Potential Areas for Further Study
This project is primarily a translational research since it focuses on moving evidence-based recommendations to clinical practice. According to the Office for Translational Research (n.d.), this research is defined as the process of applying insights, ideas, and discoveries obtained through scientific inquiry into the prevention and/or treatment of human disease. The underlying concept or philosophy of translational research is moving basic research to patient care. As a result, the underlying concept behind translational research is commonly known as “bench-to-bedside” (Woolf, 2008, p.211). Throughout the field of healthcare, translational research is utilized as the premise for promoting changes in clinical practice in order to enhance patient outcomes across various clinical settings. For example, this concept has been utilized in the field of medicine or pharmacy to promote the development of new drugs and is commonly known as translational medicine. In this regard, the relevant healthcare professionals harness knowledge from basic sciences to develop new drugs and medical equipment for treatment of patients.
As translational research, this study seeks to promote changes in contraception education of child-bearing women, particularly in obstetric and gynecological settings that have no language or cultural barriers between healthcare providers and patients. The study seeks to determine evidence-based educational strategies that enhance contraception knowledge among child-bearing women in order to enhance their outcomes. The identified evidence-based educational strategy will be utilized to promote changes in clinical practice in the obstetric and gynecology setting. In this case, this translational research will promote the use of better educational strategies by care providers in obstetrics and gynecology settings to lessen unwanted pregnancies and STDs among child-bearing women.
While this study/project will provide considerable insights on how to enhance contraception knowledge, there are some potential areas of further study relating to this topic. First, there is need to conduct further studies on the extent with which structured contraception counseling reduces unwanted pregnancies and STDs. This study simply focuses on the identification of the most suitable educational strategy, which does not include how it reduces unwanted pregnancies and STDs. Secondly, the project only utilizes one example of a structured contraception counseling i.e. the Balanced Counseling Strategy. There is need for further studies to explore other kinds or examples of structured contraception counseling with respect to their impact on enhancing contraception knowledge.
In conclusion, this project seeks to examine the impact of structured contraception counseling in enhancing contraception knowledge among child-bearing women in comparison to routine contraception counseling. The project will be carried out in a private Obstetric and Gynecology (OB/GYN) outpatient clinic. The research design to be utilized in conducting this project is quantitative pretest-posttest research methodology in which data will be collected from an experimental group and control group. Data will be collected using Contraception Knowledge Assessment tool and statistically analyzed to determine the most suitable educational strategy for enhancing contraception knowledge among child-bearing women.
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