Contraceptive Posters Improve Knowledge, Aid Patient Choice

Nancy A. Melville

January 08, 2019

Even brief exposure to educational posters that clearly describe different contraception options and their reliability is effective in boosting women's understanding of the issues, and a new patient-centered poster appears even better than a standard poster issued by the Centers for Disease Control and Prevention (CDC), according to a new randomized study.

"Clinicians often struggle to educate their patients about the multitude of important health topics in the limited amount of time they have during appointments," say the authors of the study, published in the January issue of Obstetrics & Gynecology

"Using these posters in practice could allow doctors to spend more of their time answering questions about the patient's specific contraceptive needs rather than educating them on the basics of how each method works and how effective it is," add Seri Anderson, PhD, MPH, and colleagues with the Departments of Health Policy and Management, Family Medicine, and Maternal and Child Health, at the University of North Carolina at Chapel Hill.

Contraceptive knowledge among US women appears to be alarmingly low, with studies showing at least half underestimate the effectiveness of contraceptives in the prevention of pregnancy.

Yet educational posters displayed in the exam or waiting room can be simple but powerful decision aids, increasing patients' knowledge and helping to reduce conflict in decision-making.

While the CDC recommends its own poster as a useful tool, Anderson and colleagues suggest that the CDC's poster has some shortcomings.

"The CDC's poster may not improve knowledge of the risk of pregnancy with unprotected sex, which is an important risk factor for inconsistent or non-use of contraceptives because it does not include this information," they write.

In addition, the CDC poster design may be difficult to interpret for women with low health literacy or numeracy, they add.

Improved Poster, Better Knowledge of Contraception Despite Brief Look

In an effort to improve on the CDC poster, the authors designed a "patient-centered" poster depicting the efficacy of contraception strategies ranging from "no birth control" to the methods considered most effective, including implants, intrauterine device (IUD), vasectomy, or tubal ligation, which is described as being 150 times more effective than no birth control.

To compare the effects of the two posters on patients' contraceptive knowledge and decision-making, the authors randomized 990 people recruited through the Amazon Mechanical Turk tool to complete an online survey after viewing either the CDC poster or new patient-centered poster for as long as they desired, with a 1-minute minimum.

Although viewers of both posters showed significant improvements compared with baseline in the primary outcome, a measure known as the Contraceptive Knowledge Assessment, viewers of the patient-centered poster showed significantly greater improvement compared with the CDC poster (+6.4 vs +3.6 percentage points; P < .001).

There were meanwhile no significant differences between the posters in the other two primary outcomes of perceived pregnancy risk and effectiveness of the contraceptive the woman intended to use in the next year.

For the latter outcome, both groups showed an improvement of 3 percentage points compared with baseline (P < .01), which the authors underscore is a notable change.

"This is equivalent to 1 to 17 of every 100 women who viewed a poster changing their intentions in favor of a more effective contraceptive," they write.

And importantly, the results were seen after exposure to the posters for only a brief amount of time.

"We [saw] these results despite participants only being exposed to the poster passively and for a very short period of time, similar to what they might experience if viewing the posters while waiting in a clinician's office," they state.

Improvements Seen Across the Board

Despite the study sample including more educated women than the general population of US women, participants had a baseline score of only about 66% correct on the Contraceptive Knowledge Assessment. And the majority of women believed they had a very low risk of getting pregnant, with only 23% to 24% of respondents having an accurate pregnancy risk perception, the authors say.

The improvements in scores from baseline were meanwhile seen across subgroups of patients including those with low numeracy skills, prior pregnancy scares, no use of birth control, and those who may have had greater challenges understanding information about contraception.

The study's limitations include the fact that the results of the study sample, recruited using Amazon Mechanical Turk, may not be generalizable to the general population of US women, and the study was not able to assess the effect of the posters on actual behaviors.

"The effect of these posters on actual contraceptive choices in clinical practice should be studied in future research," the authors conclude.

The study received support from the National Center for Advancing Translational Sciences, National Institutes of Health, Population Research Infrastructure Program awarded to the Carolina Population Center at the University of North Carolina (UNC) at Chapel Hill by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and from the UNC-Chapel Hill Department of Family Medicine Small Grants program.

Obstet Gynecol. 2019;133:53-62. Abstract

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