Women's perceptions and reasons for choosing the pill, patch, or ring in the CHOICE study: a cross-sectional survey of contraceptive method selection after counseling

Abstract

Background: The European CHOICE study was a cross-sectional survey that evaluated women's combined hormonal contraceptive choices before and after contraceptive counseling in Austria, Belgium, Czech Republic and Slovakia, the Netherlands, Poland, Sweden, Switzerland, Israel, Russia, and Ukraine. The changes in method selection before and after counseling were reported previously. In this paper we present the reasons given by the 18,787 participating women for selecting their contraceptive method of choice, as well as their perceptions about the contraceptive pill, patch, and ring after counseling.

Methods: Women with an interest in a combined hormonal contraceptive method (pill, patch, or ring) were counseled using a standardized counseling leaflet. The women completed questionnaires, which included questions on why they had selected a particular method of contraception, and the extent to which they agreed with statements about the attributes of the pill, patch, and ring. The results for each country were compared with the percentages for all countries combined by using a binomial regression model. Multiple logistic regression models were used to investigate the extent to which the probability of choosing a method was related to prespecified aspects (i.e. perceptions) of each contraceptive method.

Results: 'Easy to use', 'convenience', and 'regular menstrual bleeding' were important selection criteria. 'Nondaily administration' was one of the main reasons women selected the patch or ring. 'Daily use' and 'will forget to take it' were the primary reasons for not selecting the pill, while the main reasons for not choosing the patch included 'not discrete, visible' and 'can fall off'. In a small number of instances, the ring was rejected because some women don't like to use a 'foreign body'. Women's perceptions influenced their contraceptive decisions: positive perceptions about a method increased the likelihood that a woman would select it. After counseling, many women associated the pill with forgetfulness, and many still did not know about the patch or ring's key attributes. Women's knowledge about a particular method was generally greater if they had chosen it.

Conclusions: To support informed contraceptive decision-making, healthcare professionals should realize that a woman's view of a method's ease of use is more important than perceived efficacy, tolerability, health benefits, or risks.

Figure 1

Difference in proportions between women’s selection of a contraceptive method after counseling versus before counseling (using questionnaires where both post-counseling and pre-counseling contraceptive choices were non-missing). Pill, combined oral contraceptive pill; patch, transdermal patch; ring, vaginal ring; other method, other contraceptive method; undecided, women did not show a preference for the pill, patch, ring, or other method. ^aP < 0.001; ^b0.001 ≤ P < 0.01; ^c0.01 ≤ P < 0.05; ^dnot significant (P ≥ 0.05).

Figure 2

Results of the multiple logistic regression analyses relating to a woman’s likelihood of choosing the pill, patch, or ring to the perception statements about these methods. The models fit the data well (c-statistic was 0.795, 0.802, and 0.820 for the models for the pill, patch, and ring, respectively, which was considered acceptable to excellent discrimination). The likelihood of selecting the pill, patch, or ring is higher if the odds ratio (OR) is > 1 or lower if the OR is < 1 for women who ‘strongly agree/agree’ (or ‘strongly disagree/disagree’) compared with women who indicated they had ‘no opinion’ or ‘do not know’ about the perception statement in relation to the method. Two-sided 95% confidence intervals (CIs) are based on asymptotic normality of the OR estimates. The likelihood of selecting a method is higher (by a statistically significant margin at 5% level) if the lower limit of the CI is > 1. Conversely, the likelihood of selecting a method is lower (by a statistically significant margin at 5%) if the upper limit of the CI is < 1. If the CI contains 1, women who ‘strongly agree/agree’ (or ‘strongly disagree/disagree’) compared with those who had ‘no opinion’ or ‘do not know’ do not differ by a statistically significant margin with respect to the probability of choosing the method.