Research
General gynecology
Tailored intervention to increase dual-contraceptive method use: a randomized trial to reduce unintended pregnancies and sexually transmitted infections

Presented at the 34th Annual Scientific Meeting of the Infectious Diseases Society for Obstetrics and Gynecology, Boston, MA, Aug. 9-11, 2007, and the Annual Scientific Session of the St Louis Gynecological Society, St Louis, MO, April 17, 2007.
https://doi.org/10.1016/j.ajog.2008.01.038Get rights and content

Objective

The objective of the study was to determine whether a transtheoretical model–tailored expert system intervention increases dual-method contraceptive use, compared with a nontailored educational intervention.

Study Design

We performed a randomized clinical trial of 542 women at high risk for sexually transmitted infections (STIs) and unintended pregnancy. The intervention group received computer-based tailored feedback using a multimedia program. The control group received general contraceptive information and nontailored advice.

Results

Participants in the intervention group were more likely to report use of dual contraceptive methods during follow-up (adjusted hazard rate ratio 1.70, 95% confidence interval 1.09, 2.66), compared with controls. However, there were no differences in the rates of incident STI or unintended pregnancy between the 2 groups.

Conclusions

The computer-based transtheoretical model–tailored intervention resulted in a 70% increase in reported dual-method contraceptive use in a group of women at high risk for STIs and unintended pregnancy. Inconsistent use of dual methods may explain the lack of effect on unintended pregnancy rates and incident STIs.

Section snippets

Materials and Methods

A complete and detailed report of the methods of Project PROTECT is described elsewhere6; a summary of these methods is provided in the following text. Institutional review board approval was obtained before the initiation of recruitment. Between October 1999 and October 2003, we screened and recruited 542 participants. To be eligible for the trial, women had to be English speaking, between the ages of 13 and 35 years, sexually active with a male partner in the past 6 months, and at high risk

Results

Of the 1112 women screened for Project PROTECT, 916 were eligible (Figure 1). We collected data on age, race, unintended pregnancy and STI history, and contraceptive use on all patients screened. The characteristics of the patients randomized (n = 542) were similar to the patients screened eligible but not enrolled (Table 1). However, patients enrolled were more likely to be non-Hispanic black (26% vs 19%) and somewhat less likely to use hormonal contraceptive methods (33% vs 38%).

The

Comment

The intervention based on the transtheoretical model of behavior change resulted in an increase in our primary behavioral outcome, self-reported dual-method contraceptive use, compared with the control. However, there were no differences in the number of incident STIs or unintended pregnancies. It is possible that the intervention was more effective at the reported initiation of dual-method use, but the duration of use and adherence were not sustained long enough to translate into a reduction

Acknowledgments

The authors acknowledge Joseph Hogan, ScD (Center for Statistical Sciences, Brown University, Providence, RI) for his early contributions to the study design and statistical analysis.

References (16)

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    At 3-month follow-up, a smaller proportion of participants in the intervention group had unintended pregnancies (0.9%) compared to the control group (3.8%), though this difference was not statistically significant. A TTM-based intervention focused on increasing dual-method uptake and adherence among women in the US found no significant difference in rates of unintended pregnancy between intervention and control groups at 24-month follow-up (HR=1.22, 95% CI 0.73–2.04) [29]. However, the authors noted limited power to detect effects of interest due to increased use of condoms in the control arm.

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    More recently, an uncontrolled pilot study that assessed a single-session, computer-delivered TTM intervention to increase condom use found that this technology was acceptable and feasible in a group of high-risk female adolescents.16 A randomized controlled trial that delivered a TTM-tailored intervention with computer-based tailored feedback that targeted dual-method contraception use among 542 women (median age of participants was 22 years old), did not find an effect for incident STD outcomes.17 Although the TTM provides a framework for assessment of readiness to change, motivational interviewing (MI) provides an empirically-supported style for matching counseling to an individual’s readiness to change.18

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This study was supported by Grants R01-HD36663 and K24 HD01298 from the National Institute of Child Health and Human Development.

Cite this article as: Peipert JF, Redding CA, Blume JD, et al. Tailored intervention to increase dual-contraceptive method use: a randomized trial to reduce unintended pregnancies and sexually transmitted infections. Am J Obstet Gynecol 2008;198:630.e1-630.e8.

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