Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
Division of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.
BMJ Sex Reprod Health. 2022 Apr;48(2):128-136. doi: 10.1136/bmjsrh-2021-201265. Epub 2022 Jan 31.
This trial aimed to evaluate effects of structured contraceptive counselling among non-migrants, foreign-born migrants and second-generation migrants.
A cluster randomised controlled trial was conducted in 2017-2019 at abortion, youth and maternal health clinics in Stockholm, Sweden (the LOWE trial). Patients were eligible if they were 18 years or older, could understand Swedish or English (or if assisted by an interpreter), were sexually active or planning to be, and were seeking contraception for pregnancy prevention. We randomised clinics at a 1:1 allocation ratio to give either structured contraceptive counselling (intervention) or to maintain standard contraceptive counselling (control). Blinding was not deemed feasibile. A study-specific package for structured contraceptive counselling was used and comprised an educational video, an effectiveness chart, four key questions and a box with contraceptive models. Outcomes were effects of the intervention on long-acting reversible contraception (LARC) choice, initiation and use, and satisfaction with the intervention material among the participants.
We involved 14 clinics in each of the intervention and control groups, respectively. A total of 1295 participants were included: 1010 non-migrants, 169 foreign-born migrants and 116 second-generation migrants. Participants in the intervention group chose LARC to a higher extent than the control group (adjusted OR (aOR) 2.85, 95% CI 2.04-3.99), had higher LARC initiation rates (aOR 2.90, 95% CI 1.97 to 4.27) and higher LARC use within the 12-month follow-up period (aOR 2.09, 95% CI 1.47 to 2.96). The majority of the participants who received the intervention package found all the different parts to be supportive in contraceptive choice. The effectiveness chart was the only part of the package that a higher proportion of foreign-born migrants (58/84, 69%) and second-generation migrants (40/54, 74.1%) found supportive in contraceptive choice compared to non-migrants (259/434, 59.7%) (p = 0.048).
Structured contraceptive counselling increased LARC choice, initiation and use, controlled for participants' migration background. The effectiveness chart was found to be significantly more supportive among foreign-born migrants and second-generation migrants compared to non-migrants when choosing contraceptive methods.
NCT03269357.
本试验旨在评估针对非移民、外国出生移民和第二代移民的结构化避孕咨询的效果。
2017 年至 2019 年，在瑞典斯德哥尔摩的堕胎、青年和母婴保健诊所进行了一项集群随机对照试验（LOWE 试验）。如果患者年龄在 18 岁或以上，能够理解瑞典语或英语（或在口译员的协助下），有性行为或计划有性行为，并且正在寻求避孕以预防怀孕，则符合条件。我们以 1:1 的比例随机分配诊所，给予结构化避孕咨询（干预组）或维持标准避孕咨询（对照组）。未考虑盲法的可行性。使用了专门用于结构化避孕咨询的研究包，其中包括教育视频、效果图表、四个关键问题和一个带有避孕模型的盒子。结果是干预措施对长效可逆避孕（LARC）选择、开始使用和使用的影响，以及参与者对干预材料的满意度。
我们在干预组和对照组中分别涉及 14 家诊所。共有 1295 名参与者入选：1010 名非移民、169 名外国出生移民和 116 名第二代移民。与对照组相比，干预组参与者选择 LARC 的比例更高（调整后的比值比（aOR）2.85，95%置信区间（CI）2.04-3.99），LARC 起始率更高（aOR 2.90，95%CI 1.97 至 4.27），在 12 个月的随访期间 LARC 的使用率更高（aOR 2.09，95%CI 1.47 至 2.96）。大多数接受干预包的参与者发现所有不同的部分都有助于避孕选择。与非移民（59/741，8.0%）相比，图表是唯一一种外国出生移民（84/84，100%）和第二代移民（54/54，100%）发现对避孕选择更有支持作用的部分，而不是移民（259/434，59.7%）（p=0.048）。
结构化避孕咨询增加了 LARC 的选择、开始使用和使用，控制了参与者的移民背景。当选择避孕方法时，效果图表在外国出生移民和第二代移民中比非移民更具支持性。
NCT03269357。
