Comprehensive counseling about combined hormonal contraceptives changes the choice of contraceptive methods: results of the CHOICE program in Sweden.

OBJECTIVE

To study the influence of counseling on women's contraceptive decisions.

DESIGN

A cross-sectional multicenter study.

SETTING

Seventy Swedish family planning clinics.

POPULATION

Women aged 15-40 years attending for a contraceptive consultation who expressed interest in a combined hormonal contraceptive (CHC) method.

METHODS

Structured counseling about three CHCs and questionnaires completed after counseling from the healthcare professional.

MAIN OUTCOME MEASURES

Method originally requested, perceptions of CHC attributes, method chosen and reasons for the choice.

RESULTS

In all, 173 healthcare professionals and 1,944 women participated. The mean standard deviation (SD) age of the women was 22.6(6.1) years. After structured counseling, a majority of women (56.0%; n=1 069; 95% confidence interval (CI) 53.1-58.9) chose the daily pill, 6.2% (n=118; 95% CI 4.9-7.8) chose the weekly patch, and 22.5% (n=430; 95% CI 20.2-25.1) chose the monthly ring. The weekly patch was chosen more often after counseling (6.2 vs 2.4% before counseling; p<0.0001). The greatest change was in the proportion of women who chose the contraceptive ring after counseling (22.5% vs. 8.5% before counseling; p<0.0001). The proportion of undecided women after counseling was reduced considerably (3.9% vs. 27.8% before counseling). Among the 523 women who were undecided before counseling, 50.6% chose the pill, 10.2% the patch and 24.6% the ring, while 20.9% of women who initially requested the pill changed to another method.

CONCLUSIONS

Structured counseling facilitated choice of contraceptive method for most women, leading to changes in women's selection of a CHC method.