Contraceptive Fact Sheet Quickly Boosts Women's Knowledge

Marcia Frellick

February 06, 2015

Because isotretinoin, an effective treatment for acne, can cause birth defects, the US Food and Drug Administration (FDA) requires women of child-bearing age who use the drug to use two forms of contraception.

However, pregnancies and birth defects continue to occur among patients taking the drug. The researchers suspected a lack of knowledge about the effectiveness of forms of birth control and tested the benefit of a one-page information sheet. More knowledge, they reason, could promote safer use of isotretinoin.

Carly A. Werner, MD, from the University of Pittsburgh in Pennsylvania, and coauthors developed surveys to assess the knowledge of 100 women who visited a dermatology practice regarding eight forms of contraception. Their results were published online February 4 in JAMA Dermatology.

The authors found that before viewing the information sheet, more than half of the women (mean age, 27.5 years; most with a college education) overestimated the typical effectiveness of condoms, contraceptive injections, and oral contraceptives. Participants were able to correctly identify the typical effectiveness of an average of about half of the eight contraceptives.

After a mean of 31 seconds of viewing the sheet, the improvement in knowledge was dramatic. The increase in percentage of women able to identify the typical effectiveness was as follows:

  • subdermal implant (increased from 45% correct to 78% correct; P < .001),

  • intrauterine device (increased from 61% to 83%; P < .001),

  • injection (increased from 28% to 44%; P = .02),

  • ring (increased from 60% to 69%; P = .18),

  • patch (increased from 50% to 71%; P = .002),

  • pills (increased from 41% to 65%; P < .001),

  • condoms (increased from 25% to 45%; P = .003), and

  • withdrawal (increased from 74% to 90%; P = .003).

The authors note that even after reading the sheet, 55% of participants still overestimated the typical effectiveness of condoms and showed little knowledge of some of the most effective forms of birth control: intrauterine devices and subdermal implants.

Increased knowledge of contraception may help promote safer use of isotretinoin, the authors say. The US Food and Drug Administration's iPLEDGE program requires, in addition to the two-contraceptive promise, that women complete monthly serum pregnancy tests and online tests of their knowledge of the risks of the drug.

That has had the unintentional effect of limiting the drug's use for women with severe skin disease and has only minimally increased contraceptive use. In the first year of the program, 122 pregnancies affected by isotretinoin were reported.

"We have developed a 1-page contraceptive information sheet that increases women's knowledge of the typical effectiveness of available contraceptives and can be easily integrated into existing dermatology practice. Addition of this information sheet to the materials distributed by the iPLEDGE program may help decrease the number of isotretinoin-exposed pregnancies," the authors conclude.

In a related invited commentary, Marie Leger, MD, PhD, from the Ronald O. Perelman Department of Dermatology at New York University, New York City, said the study shows that even a small investment such as this information sheet has significant results and may go a long way in safer use of an effective drug.

She notes that efficacy rates are 60% to 85%, making isotretinoin the closest thing dermatologists have to an acne "cure."

"Because multiple studies closely link women's contraceptive knowledge with their contraceptive use, increasing patient knowledge should lead to more effective contraceptive choices," she writes. "Closing this practice gap could both prevent pregnancies in patients receiving isotretinoin and help ensure that dermatologists do not inadvertently undertreat acne in women."

This study was funded in part by the US Food and Drug Administration. The authors and Dr Leger have disclosed no relevant financial relationships.

JAMA Dermatol. Published online February 4, 2015. Abstract


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