Effect of peer counselors on adolescent compliance in use of oral contraceptives. Effect of counseling to improve compliance in Mexican women receiving depot-medroxyprogesterone acetate. Compliance with depot medroxyprogesterone acetate: a randomized, controlled trial of intensive reminders. Impact of an intervention to improve contraceptive use through follow-up phone calls to female adolescent clinic patients. Using daily text-message reminders to improve adherence with oral contraceptives: a randomized controlled trial. Success with oral contraceptives: a pilot study.
Poor compliance with contraceptive regimens has been shown to be an important antecedent of adolescent pregnancy. The purpose of this study was to test prospectively the effect of a peer v nurse counseling program on adolescent compliance with the use of oral contraceptives. Fifty-seven females aged 14 to 19 years from a lower socioeconomic background were randomly assigned to a peer (n = 26) or nurse (n = 31) group. At the initial visit and at 1-, 2-, and 4-month follow-up visits, subjects received Ortho-Novum 1/35 combined with a tablet marker and were counseled by a nurse or peer. Noncompliance was measured using a Guttman scale consisting of: (1) avoidance of pregnancy, (2) appointment adherence, (3) pill count, and (4) urinary fluorescence for riboflavin. At the first and second follow-ups, the adolescents counseled by a peer had a significantly (P less than or equal to .038) lower noncompliance level than the nurse-counseled group. Adolescents with more frequent sexual activity (P less than or equal to .027), with one sexual partner (P less than .04), and who worried that they might become pregnant (P less than or equal to .01) had significantly lower levels of noncompliance when counseled by a peer than by a nurse. At the fourth month follow-up, adolescents who expressed feelings of hopelessness about the future had significantly (P less than or equal to .036) higher levels of noncompliance when counseled by a nurse than when counseled by a peer. These results suggest that incorporating a peer counselor into the health care team may be an effective method of increasing adolescent compliance. This study purported to determine the effect of pretreatment counseling upon discontinuation of 150 mg depot-medroxyprogesterone acetate (Depo-Provera) given for contraception. A total of 350 Mexican women participated: 175 received detailed structured pretreatment counseling about the hormonal effects of the injectable vs. routine counseling upon duration of use and efficacy of the method. Study termination rates were significantly lower in the structured counseling group than in the control group. Cumulative life table discontinuation rates were 17% (30/175) and 43.4% (76/175), respectively (p <0.05). The most common reasons for terminating DMPA were menstrual changes (8.6 and 32% for counseling and control group, respectively). The findings suggest that pretreatment counseling on expected side effects increases the continuation rates of DMPA users. We enrolled women in a prospective, randomized study to determine whether an intensive reminder system would improve compliance in women receiving depot medroxyprogesterone injections. Women selecting this treatment were assigned to a group that received both mail and telephone reminders or to a second group that received only a scheduled appointment at the time of the previous injection. The rate of continuation and the rate of on-time injections did not differ between groups. Women who had prolonged bleeding were more likely to discontinue depot medroxyprogesterone injections. Adolescent females often have questions or concerns about their contraceptive methods, and they may discontinue use if these questions are not answered. Little evidence exists on whether follow-up phone calls to address young women's concerns can help sustain contraceptive use.
                Between 2005 and 2007, a total of 805 females aged 14-18 attending a reproductive health clinic in San Francisco were randomly assigned to receive either regular clinic services or regular clinic services plus nine follow-up phone calls over 12 months. The young women were surveyed at baseline and roughly six, 12 and 18 months later to measure condom and contraceptive use, rates of pregnancy and STDs, and other outcomes and mediators. Multiple linear and logistic regression repeated measures analyses were used to assess the program's effects.
                Clinic counselors completed only 2.7 calls per patient, and made 7.8 attempts for every completed call. Although contraceptive use increased from baseline to follow-up at six months in both groups, levels of condom and contraceptive use, and rates of pregnancy and STDs, did not differ between the intervention and control groups at any of the follow-up assessments. Moreover, the intervention did not improve clinic utilization or satisfaction or have consistent positive effects on participants' attitudes.
                Reaching young women by phone after a clinic visit for contraception is challenging and does not appear to provide significant benefits beyond those provided by basic clinic services. More intensive interventions may be needed to markedly change adolescent sexual and contraceptive behavior.
                Copyright © 2010 by the Guttmacher Institute. To estimate whether women receiving daily text-message reminders have increased oral contraceptive pill adherence compared with women not receiving reminders.
                This randomized controlled trial estimated whether there was an effect of daily text-message reminders on oral contraceptive pill adherence of new oral contraceptive pill users. Pill-taking was tracked for 3 months by an electronic monitoring device with wireless data collection. During the study period, participants assigned the intervention received a daily reminder text message. Eighty-two women were assigned randomly to detect a 1.6+/-2.0 pill difference (90% power, 5% alpha, 15% dropout).
                Participants were 79% white, non-Hispanic, 99% high school graduates, and 99% nulliparous with a mean age of 22 years. Most reported condom use with past coital activity, and more than half reported prior emergency contraception use. The mean number of missed pills per cycle did not differ significantly between the groups: 4.9+/-3.0 for the text-message group and 4.6+/-3.5 for the control group (P=.60). The number of missed pills per cycle increased over the course of the study, but this pattern did not increase differentially between the groups. Adherence recorded by the electronic monitoring device indicated much poorer adherence than that recorded by patient diaries. Despite poor pill-taking, there were no pregnancies.
                Daily text-message reminders did not improve oral contraceptive pill adherence. Although the lack of benefit may be attributed to the frequent use of alternative reminder systems in the control group, the rate of missed pills when measured objectively was still very high in both groups.
                Clinicaltrials.gov, www.clinicaltrials.gov, NCT00733707.
                I. The objective of this pilot study was to examine the effectiveness of a postpartum educational intervention aimed at increasing compliance with oral contraception (OCs) and decreasing repeat pregnancies in young, African American women in the year following an unplanned pregnancy. In this longitudinal study, 43 young, pregnant women attending Prentice Ambulatory Care, Northwestern Hospital, were enrolled and 33 were randomized to receive an antepartum, multicomponent intervention consisting of counseling, a videotape about OCs and written material or resident-physician counseling (usual care). Questionnaire data were collected at enrollment, immediately following the intervention, at 6 weeks, 6 months and 12 months. At 1 year, 25 women remained in the study. More women in the intervention group were not pregnant and still using contraception, and were able to successfully switch contraceptive methods compared to women in the control group. There was no decrease in repeat pregnancy in the intervention group at 1 year compared to the control group. Our intervention resulted in a sustained increase in knowledge of OCs throughout the study period. However, more is needed to promote postpartum contraceptive compliance and decrease repeat pregnancies in young, low-income African Americans with unintended pregnancies.