Introducing reproductive life plan-based information in contraceptive counselling: an RCT

Abstract

Study question: Can reproductive life plan (RLP)-based information in contraceptive counselling before pregnancy increase women's knowledge of reproduction, and of the importance of folic acid intake in particular?

Summary answer: The RLP-based information increased women's knowledge of reproduction including knowledge of folic acid intake.

What is known already: Many women have insufficient knowledge of reproduction, including a health-promoting lifestyle prior to conception, and highly educated women in particular postpone childbearing until an age when their fertile capacity has started to decrease.

Study design, size, duration: The study was an randomized controlled trial with one intervention group (IG) and two control groups (CG1, CG2). A sample size calculation indicated that 82 women per group would be adequate. Recruitment took place during 3 months in 2012 and 299 women were included. The women were randomized in blocks of three. All groups received standard care (contraceptive counselling, Chlamydia testing, cervical screening). In addition, women in the IG were given oral and written RLP-based information about reproduction.

Participants/materials, setting, methods: A total of 299 out of 338 (88%) Swedish-speaking women visiting a Student Health Centre were included (mean age 23 years); response rate was 88%. Before the counselling, women in the IG and the CG1 completed a baseline questionnaire, including questions about lifestyle changes in connection to pregnancy planning, family planning intentions and knowledge of reproduction (e.g. the fecundity of an ovum). At follow-up 2 months after inclusion, a structured telephone interview was performed in all groups (n = 262, 88% participation rate).

Main results and the role of chance: There was no difference between the groups regarding the mean knowledge score at baseline. The IG scored higher at follow-up than at baseline (P < 0.001); the mean increased from 6.4 to 9.0 out of a maximum 20 points. The women in the CG1 scored no differently at follow-up than at baseline. The difference in the knowledge score between the IG and the two CGs was significant (P < 0.001), whereas no difference was shown between the two CGs. There was no difference between the groups at baseline regarding how many women could mention folic acid intake among the things to do when planning to get pregnant. At follow-up, 22% in the IG, 3% in CG1 and 1% in CG2 mentioned folic acid intake (P < 0.001). At follow-up, more women in the IG also wished to have their last child earlier in life (P < 0.001) than at baseline, while there was no difference in the CG1.

Limitations, reasons for caution: As the study sample consisted of university students, it is possible that the effect of the intervention was connected to a high level of education and conclusions for all women of reproductive age should be drawn with caution.

Wider implications of the findings: The provision of RLP-based information seems to be a feasible tool for promoting reproductive health.

Study funding/competing interest(s): Study funding was received from the Faculty of Medicine, Uppsala University, Sweden. There are no conflicts of interest.

Trial registration number: ClinicalTrial.gov Identifier NCT01739101.

Keywords: fertility; health education; pregnancy; reproductive health.

Figure 1

CONSORT flow diagram for the randomized controlled trial (RCT) to study the benefit of using RLP-based information in contraceptive counselling.

Figure 2

RLP-based interview guide used by the midwives during the intervention.

Figure 3

Information given to the intervention group, both verbally by the midwives during the counselling and in written form in the brochure.