My Birth Control tool improves counseling for patients and providers
There’s not a lot of research on how to implement contraceptive counseling that’s respectful of and responsive to patients’ preferences, needs and values. Providing this care is particularly important given the shameful historical and ongoing reproductive coercion and oppression in the United States, as well as the fact that studies have indicated that women of color may be less likely to receive that care and are more likely to be pressured to use contraception. In the health communication field more broadly, there has been increasing attention to shared decision-making, an approach to medical decisions that accounts for the importance of patients’ preferences and values alongside providers’ medical expertise. This model of counseling is particularly relevant to decisions where there are multiple options that are medically appropriate, such as contraceptive choice. Decision support tools for patients have been shown to successfully support this approach to counseling.
In order to promote a shared decision-making approach to contraceptive counseling and improve patient experiences selecting a birth control method, the Person-Centered Reproductive Health Care Program (PCRHP) created a decision support tool called My Birth Control, and tested its impact on both patients and providers. My Birth Control is an interactive tool designed to be used on an iPad before a visit with a provider. It takes users through a series of educational modules and then a survey on their preferences for method characteristics. The answers are used to generate recommendations for methods that match their preferences, which can help users choose which methods they would like to talk about with their provider. The tool then generates a contraceptive profile which captures the methods they are interested in, as well as their contraceptive preferences, medical issues that impact which methods they can use, and questions they may have typed for their provider. This information can be printed and given to the provider to inform personalized counseling.
PCRHP tested the tool through a cluster randomized controlled trial with a racially and socioeconomically diverse sample at four safety net clinics in San Francisco. They found a positive impact on several patient-centered outcomes, including experience of contraceptive counseling, decision quality and knowledge of contraceptive options among the set of patients who used the tool. The positive effects on knowledge and patient satisfaction with counseling indicate that My Birth Control contributes to women receiving higher quality contraceptive care.
The research team also analyzed audio recordings of counseling sessions to see if there were differences in patient-provider communication in counseling between those who did and did not use the tool. This analysis also provided evidence that counseling visits using My Birth Control were more patient-centered than those where patients and providers did not use the tool. For example, use of the tool printout helped ensure that counseling was initiated with a focus on patient preferences rather than providers emphasizing long-acting reversible contraception, which had been the case in many sessions recorded pre-tool use. Additionally, the post-implementation recordings revealed that many women gained knowledge from the tool that they were able to incorporate into their dialogue with providers about what methods would be best for them.
PCRHP also conducted interviews with providers who used the tool to see how it impacted their counseling and if they found it useful for their practice. The providers repeatedly emphasized that the tool impacted how they used their time in visits and felt that it made the counseling more direct and efficient. They also felt that it improved patients’ knowledge and confidence, helping them jumpstart the conversation. One provider noted, “I feel like it gave them a little bit more agency in the process.” They all felt that it was feasible to use the tool in practice and that any changes to the clinic flow or difficulties for patients unfamiliar with technology could be overcome. These positive impressions are important as previous research has shown that provider resistance to using decision support tools is a major barrier.
The combination of data about patient experience of counseling, observation of counseling sessions and feedback from providers shows that My Birth Control is effective in encouraging a patient-centered, shared decision-making approach to birth control counseling without increasing the burden on providers. Particularly given the reproductive coercion and oppression experienced by women of color and low-income women in the United States, resources like My Birth Control are valuable tools for clinics and systems to help improve patient experience with contraceptive counseling. The PCRHP is currently working with collaborators on disseminating My Birth Control in multiple contexts and adapting it for use during pregnancy and childbirth, for women in the military, and in contexts where HIV and pregnancy prevention services are integrated.