Lara C. Pullen, PhD

March 24, 2014

Social media, in combination with traditional in-office counseling, is an effective tool for improving patient contraceptive knowledge. The increased knowledge corresponded with an increased patient preference for long-acting reversible contraceptives (LARCs) in a new study.

Jason D. Kofinas, MD, from the Department of Obstetrics and Gynecology, New York-Presbyterian Hospital-Weill Cornell Medical Center in New York City, and colleagues published the results of their randomized controlled trial in the April issue of Obstetrics & Gynecology. The study included women aged 18 to 45 years who received care at an obstetrics and gynecology clinic in an urban academic center.

The study was also presented on April 29 at the annual meeting of the American Congress of Obstetricians and Gynecologists in Chicago.

The investigators randomly assigned women to receive information on contraception via standard contraceptive education and pamphlet (n = 74) or via standard contraceptive education and Facebook (n = 69). The women in the Facebook group received the same information as the women in the brochure group, but the information was provided in video, diagram, and game formats. All participants received a 15-minute one-on-one counseling session with a single healthcare provider who was blinded to the intervention group; the women then had 30 minutes to study material via pamphlets or Facebook. The authors chose to use Facebook because it is easily accessible and facilitates interaction.

The authors assessed the women's knowledge before and after the intervention, using the validated Contraception Knowledge Inventory survey. They found that women in the Facebook group had a significantly higher raw postintervention score compared with the women in the pamphlet group (P < .001), as well as a significantly greater percentage change in their score than women in the control group.

The Facebook group also had a significant preference for LARCs (P = .01).

The study did not investigate long-term knowledge retention, actual contraceptive use, or long-term compliance.

Contraception Knowledge Reduces Unintended Pregnancies

"We have shown that improving patient knowledge can improve contraceptive preference for LARCs, particularly among young women at high risk for unintended pregnancy. Studies have shown that increased use of LARCs can decrease unintended pregnancy rates. In fact, the [American College of Obstetricians and Gynecologists] strongly supports LARC use, especially in adolescent population," Dr. Kofinas and colleagues write.

Although effective conception counseling is essential for all women of reproductive age, women who are aged 25 years or younger are at particularly high risk for unintended pregnancies. Patient satisfaction is important for counseling and is likely to improve compliance with a specific treatment plan.

Patients in the Facebook group were more satisfied with the counseling method than patients in the brochure group (P < 0.001).

"[O]ur study demonstrates that providing information regarding contraceptive options through Facebook is an effective method to enhance contraceptive knowledge and preference for LARCs in patients. Future work should include long-term follow-up of a larger number of patients for contraceptive knowledge retention and use and continuation of contraception," the authors write.

Results Consistent With Other Studies

In an interview with Medscape Medical News, Dr. Kofinas described additional studies that have examined the effects of social media on contraceptive compliance. In particular, he described an elegant study that evaluated the effect of text message reminders on contraceptive compliance in a teenage population recruited out of Brooklyn Planned Parenthood.

"I believe those manuscripts and my recent contribution provide insight into how we can use technology and modern means of communication to counsel patients in new ways. This approach is not limited to gynecologists and has been used successfully with teledermatology, [which] allowed access to care in rural areas through Facebook. There are many unique ways that this technology can be used, and it is my hope that the medical community as a whole begins to explore this topic further," he explained.

Dr. Kofinas emphasized that Facebook has an extremely large and international user base and can allow the distribution of medically sound information in a way that increases patient knowledge.

"I would applaud the efforts to do anything to decrease unplanned pregnancies," agreed Linda Bradley, MD, vice chair of obstetrics and gynecology at the Cleveland Clinic in Ohio, in a telephone interview with Medscape Medical News. She added that to the best of her knowledge, the Cleveland Clinic does not use social media to improve contraception education or compliance.

"I think that you will have a slow uptake by the medical community as a whole. I think this reflects the wide range of physician practices and what each individual physician is comfortable employing," Dr. Kofinas noted. He added, however, that as the new generation of physicians begins to practice medicine, there will be a larger use of social media. He imagines that the younger physicians will see social media as a means to control the quality of medical information that is available via this important route.

Privacy Yet to be Resolved

Dr. Kofinas acknowledged that privacy details still need to be worked out: "I think when you have publicly accessible information and the ability to have open forum discussion, there is always a risk of breach of privacy."

The use of social media assumes that the user realizes that Facebook is a public platform and that any and all questions and posts will be public. Although the article demonstrates that Facebook is an excellent way to disseminate information to a large number of people, it does not address privacy concerns, the authors note.

The research was partially funded by a Bayer Health Care Pharmaceuticals Research Fellowship in Oral Contraceptive Benefit/Risk Communication to Dr. Kofinas. The authors have disclosed no other relevant financial relationships. Dr. Bradley serves as a consultant to Bayer.

Obstet Gynecol. 2014;123:763-770. Abstract

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