Contraception Counseling Strategies in OB/GYN Outpatient Settings

Introduction: The Case for Improved Contraception Education

Proper contraception usage is one of the most important factors in improving patient outcomes in the obstetrics and gynecology setting. A search of existing literature has demonstrated that contraception use differs among patient populations, and that 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 educate patients on contraception use. These tools range from verbal education to visual aids such as cue cards and pamphlets that patients can take home to reinforce information communicated in the clinic (Lee, 2014). However, there is a need for additional materials and strategies to help patients understand proper contraception use. While the use of various teaching tools helps to enhance patients' knowledge, proper contraception usage requires better strategies — strategies that would meet the need for additional materials and methods to promote appropriate contraceptive practice.

Strategies to Move Evidence-Based Recommendations into Practice

A review of the literature has identified evidence-based recommendations that should be translated 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), various implementation and dissemination strategies exist 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 strategies are operationalized by formulating a program focused 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 of 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 across different healthcare settings (Titler, 2008). The program will be developed and implemented as a project in an outpatient obstetric and gynecology clinic. The outpatient setting provides a suitable environment for promoting enhanced contraception knowledge and usage both within and outside the hospital. The project will be designed as a multifaceted intervention strategy because such strategies have been found to be more effective in clinical settings than single-intervention strategies. Grimshaw et al. (2006) contend that multifaceted interventions are more effective than single interventions with respect to moving evidence-based recommendations into clinical practice, primarily because they address clinical practice from the perspective of the individual practitioner, the patient population, and the organization.

The project will be carried out through a series of steps. The first step entails selecting a practice topic — typically the first step in translating evidence-based research into clinical practice (Titler, 2008). This step was carried out in the earlier parts of this project, in which the researcher identified the issue of contraception usage among Chinese/Cantonese-speaking women in an outpatient obstetric and gynecology clinic. This is followed by evaluating and synthesizing existing evidence on the research issue, which was also addressed in previous segments of this DNP project. The third step involves designing a program that uses 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. The researcher will therefore utilize two interventions: the Balanced Counseling Strategy and a routine counseling strategy. Once the project is implemented, it will be evaluated in terms of the impact of the evidence-based recommendations on clinical practice, provider performance, patient care, and patient outcomes. The evaluation will also assess the setting or context in which the clinical practice was implemented.

The use of these steps as part of a multifaceted intervention strategy is attributable to the fact that they promote learning at each stage of the process. Titler (2008) states that the learning that takes place in each of these steps provides valuable insights for capturing and feeding back into the process. These insights help other clinicians in similar settings to adapt the evidence-based recommendations and implementation strategies to their own clinical practice. In essence, this project will act as a foundation through which clinicians in other settings can adapt evidence-based recommendations and implementation strategies to transform clinical practice.

This pilot project could then serve as the basis for administrative interventions — another strategy for moving evidence-based recommendations into practice. Administrative interventions entail healthcare decision making aimed at changing clinical practice (National Health and Medical Research Council, 2000). Necessary administrative steps include removing barriers to implementation of evidence-based recommendations and promoting behavioral change among clinicians. These interventions will help ensure continuity in the translation of evidence-based recommendations into clinical practice. Through this process, the validity of earlier decisions is reviewed and the need for 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 to enhance contraception use among Chinese/Cantonese-speaking women in an obstetric and gynecology outpatient setting. Drawing on insights from the evaluation of existing evidence, the researcher will develop a project that seeks to promote changes in contraception education in the clinical setting, with the goal of identifying the most effective method for improving patients' knowledge and use of contraception. The identified method will be grounded in evidence-based recommendations.

The researcher will conduct a quantitative pretest-posttest study examining the effectiveness of structured contraception counseling in improving patients' knowledge and use of contraception in comparison to routine contraception counseling. Structured contraception counseling is the main concept of interest, since current routine contraception counseling is relatively ineffective in enhancing patients' knowledge and use of contraception. The study will be conducted on a group of childbearing women who speak Chinese or Cantonese and receive gynecological services at a private obstetrics and gynecology outpatient clinic. This private clinic currently utilizes routine contraception counseling in which childbearing women receive verbal education on contraception use and are given pamphlets and cue cards as visual aids to use at home. While there are no language or cultural barriers within this homogeneous population of staff and patients, patients experience difficulties in retaining the information provided through these tools.

The Balanced Counseling Strategy (BCS) will serve as the structured contraception counseling intervention. 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 counseling cards that help explain the various methods of contraception to patients and provide an additional opportunity for reinforcement of information. Patients will also be able to take brochures and pamphlets home with them.

The quantitative pretest-posttest research design is appropriate because this methodology is well suited to comparing groups and measuring changes resulting from experimental treatments (Dimitrov & Rumrill, 2003). Alessandri, Zuffiano, and Perinelli (2017) confirm that a pretest-posttest design is appropriate for evaluating the effectiveness of intervention programs in clinical settings. Since this research seeks to examine the effectiveness of BCS relative to routine methods, the pretest-posttest design is the most suitable methodology for the project.

Participants will be divided into two groups: an experimental group and a control group, with random selection and random assignment. The experimental group will receive the Balanced Counseling Strategy, while the control group will receive only routine contraception counseling. At the outset, baseline (pretest) data will be collected from both groups regarding contraception knowledge and usage. Upon completion of the study, posttest data will be collected to determine which counseling strategy enhanced contraception knowledge and usage. The posttest data from the experimental group will be compared to the posttest data from the control group.

The Contraception Knowledge Assessment (CKA) will be used to collect posttest data from both groups to determine whether there has been an increase in patients' contraception knowledge. Several studies have identified the CKA as a useful assessment tool. As Campol et al. (2015, p. 413) note, "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." While accuracy of assessment may not always be as high as desired, the CKA offers an evidence-based, validated, and reliable evaluation of contraceptive information. It is a modern tool designed to assist in determining the effectiveness of interventions aimed at augmenting contraception education. Data obtained from the CKA will be analyzed statistically to determine the most effective method for increasing contraception knowledge and usage among childbearing women.

Conclusion

This project seeks to examine the impact of structured contraception counseling on contraception knowledge among childbearing women in comparison to routine contraception counseling. The project will be carried out in a private obstetric and gynecology outpatient clinic using a quantitative pretest-posttest research design in which data will be collected from both an experimental group and a control group. Data will be collected using the Contraception Knowledge Assessment tool and statistically analyzed to determine the most suitable educational strategy for enhancing contraception knowledge among childbearing women.

References

Albarracin, D., Johnson, B. T., Fishbein, M., & Muellerleile, P. A. (2001, January). Theories of Reasoned Action and Planned Behavior as models of condom use: A meta-analysis. Psychological Bulletin, 127(1), 142–161.

Alessandri, G., Zuffiano, A., & Perinelli, E. (2017, March 2). Evaluating intervention programs with a pretest-posttest design: A structural equation modeling approach. Frontiers in Psychology, 8, 223. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5332425/

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.

Dimitrov, D. M., & Rumrill, P. D. (2003). Pretest-posttest designs and measurement of change. Work, 20, 159–165.

Gosavi, A., Ma, Y., Wong, H., & Singh, K. (2016). Knowledge and factors determining choice of contraception among Singaporean women. Singapore Medical Journal, 57(11), 610–615.

Grimshaw et al. (2004, February). Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment, 8(6), 1–72.

Hall, K. S. (2012, January–February). The Health Belief Model can guide modern contraceptive behavior research and practice. Journal of Midwifery & Women's Health, 57(1), 74–81. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3790325/

Kulier, R., Gee, H., & Khan, K. S. (2008, May 14). Five steps from evidence to effect: Exercising clinical freedom to implement research findings. BJOG: An International Journal of Obstetrics and Gynaecology, 115, 1197–1202.

Lee, S. D. (2014). Improving contraceptive compliance through an evidence-based education program. Evidence Based Women's Health Journal, 4(1), 40–46.

Lopez, L. M., Grey, T. W., Chen, M., Tolley, E. E., & Stockton, L. L. (2009, June). Theory-based interventions for contraception. Contraception, 79(6), 411–417.

National Health and Medical Research Council. (2000, February). How to put the evidence into practice: Implementation and dissemination strategies. Retrieved from Commonwealth of Australia website: https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp71.pdf

Office for Translational Research. (n.d.). What is translational research? Retrieved from University website:

Okonofua, F. (2014, June). Revamping the reproductive health agenda in Africa after 2014. African Journal of Reproductive Health, 18(2).

Population Council. (2007). The balanced counseling strategy: A toolkit for family planning service providers working in high HIV/STI prevalence settings (3rd ed.). Washington, DC: The Population Council, Inc.

Sable, M. R., Schwartz, L. R., Kelly, P. J., Lisbon, E., & Hall, M. A. (2006, March). Using the Theory of Reasoned Action to explain physician intention to prescribe emergency contraception. Perspectives on Sexual and Reproductive Health, 38(1), 20–27.

The WHO Reproductive Health Library. (2012, April 1). Theory-based interventions for contraception. Retrieved from

Titler, M. G. (2008, April). Patient safety and quality: An evidence-based handbook for nurses. Retrieved from National Center for Biotechnology Information, U.S. National Library of Medicine website: https://www.ncbi.nlm.nih.gov/books/NBK2659/

Woolf, S. H. (2008). The meaning of translational research and why it matters. Journal of the American Medical Association, 299(2), 211–213.