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  • Title: Women's knowledge of taking oral contraceptive pills correctly and of emergency contraception: effect of providing information leaflets in general practice.
    Author: Smith LF, Whitfield MJ.
    Journal: Br J Gen Pract; 1995 Aug; 45(397):409-14. PubMed ID: 7576845.
    Abstract:
    BACKGROUND: About one third of all pregnancies are unplanned and 20% of all pregnancies end in abortion. More than 170,000 legal abortions are performed in the United Kingdom annually. Nearly all general practitioners provide contraceptive advice; the most commonly used form of reversible contraception is the oral contraceptive pill. AIM: The aim of this study was to determine factors associated with women's knowledge of taking the contraceptive pill correctly and of emergency contraception, and to investigate if their knowledge could be improved in general practice by providing women with Family Planning Association information leaflets. METHOD: An uncontrolled intervention study was performed in one rural and one urban English general practice, using a self-completion questionnaire that was initially administered to women attending their general practitioner for oral contraception over six months from 1 October 1992. The questionnaire asked for: sociodemographic information; knowledge of how late women can be taking an oral contraceptive pill and still be protected against unplanned pregnancy; for how many days after being late with a pill they need to use other precautions; sources and methods of emergency contraception; and for how long the methods are effective after the primary contraceptive failure. After completing the questionnaire women were given two leaflets: one about how to take their prescribed contraceptive pill correctly and one about emergency contraception. Three to 12 months later the same questionnaire was administered in the same manner. RESULTS: Of 449 women completing the first questionnaire, 233 (52%) completed the second questionnaire. Initially 71% of 406 women taking an oestrogen/progestogen combined pill knew about the '12-hour rule' and 17% knew about the 'seven-day rule'; giving women information about the pill they were taking increased the extent of knowledge about these rules among 212 respondents to 82% (P < 0.01) and to 25% (P < 0.05), respectively. The proportion of respondents who knew that they could obtain emergency contraception from their own general practitioner, from any general practitioner and from family planning clinics all increased after they had received the leaflets (from 84% to 92%, from 34% to 47% and from 82% to 90%, respectively, all P < 0.01). There were significant improvements in the proportion of women knowing the duration of effectiveness of emergency contraception. However, after receiving the leaflet on emergency contraception the majority of women still did not know for how long after unprotected intercourse the high-dose combined pill and the intrauterine contraceptive device were effective (80% and 93% of 233 women, respectively). Improvements in knowledge depended upon women's social class, previous use of emergency contraception and with which practice they were registered. CONCLUSION: Providing women with leaflets about taking the contraceptive pill correctly and about emergency contraception appears to improve significantly their extent of such knowledge. If such practice was adopted elsewhere this increased knowledge might reduce the number of unplanned pregnancies in the UK. The effect of general practitioners personally providing such leaflets, with or without verbal instruction, warrants further study. Beginning in October 1992, a study was undertaken in the UK to determine 1) the extent of women's knowledge of correct use of oral contraceptives (OCs) and of emergency contraception (EC), 2) which factors were associated with such knowledge, and 3) whether the provision of appropriate Family Planning Association (FPA) leaflets improved knowledge in these areas. The study was conducted simultaneously in a small, rural, nontraining practice and in a large, urban training practice. Data were gathered from anonymous, self-administered questionnaires. After completion of the questionnaires, the women were given FPA leaflets with information on OC use and emergency contraception. The same questionnaire was administered when the women returned for their follow-up appointment (3-12 months later) or by mail (449 women completed the first questionnaire and 233 completed the second). Statistical analysis of the data from the first phase of the study revealed that respondents with lower socioeconomic status were less likely to know that their OC contained two hormones. Rural respondents and those who had a history of abortion were less likely to know that they could take an OC up to 12 hours after their usual time. Urban respondents and those who has used EC were more likely to know where EC is available. Knowledge of EC was also positively related to having become pregnant by mistake and having a higher socioeconomic status. The intervention increased the proportion of women using a combined OC who knew their OC had two hormones. Knowledge also increased about the requirement for extra precautions if they took their OC more than 12 hours late (this was a significant increase among the rural women). Knowledge of sources of EC also improved (significantly for those who had never used EC and for rural women). Knowledge of the two methods of EC also improved significantly. The provision of information in the form of leaflets increased knowledge significantly. Such improved knowledge may decrease the incidence of unplanned pregnancies and, thus, of abortion. Further research is needed to determine the effect of general practitioners' personally providing the leaflets with or without verbal instruction.
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