Brave new world: Family planners use technology to enhance counseling

Internet, e-mail, and text messaging can aid contraceptive use

Your clinic has distributed brochures on contraceptive methods, put up posters in the waiting room and exam rooms, and passed out printed information along with pill packs. Still, patients aren't getting the message about how to choose and use the method that is best for them. How can you disseminate an effective message?

Clinicians are looking to electronic technology to circulate all forms of reproductive health information, including contraceptive counseling. The web is proving to be an important resource for health information; a 2009 Pew Internet & American Life Project reports that 28% of adolescents look online for health and fitness information.1

"Choosing the best method of birth control is not easy," says Melissa Kottke, MD, MPH, assistant professor in the Department of Gynecology/ Obstetrics at Emory University and director of the Jane Fonda Center, both in Atlanta. "There are so many methods and so much information."

Emory University researchers have developed "Best Method for Me," a computer-based questionnaire providing personalized output to a woman in search of a contraceptive method that suits her best. Now available on the Internet at www.bestmethodforme.com, the site offers a comprehensive set of 54 questions, which lead to a detailed output on the method best tailored for an individual woman. Since the questionnaire is web-based, women may access it at home, then bring in the results to discuss at a provider visit.

Provider contraceptive counseling remains the "gold standard," says Kottke, who spoke on the "Best Method" technology at the 2009 Contraceptive Technology "Quest for Excellence" conference.2 However, using technology in a manner that provides dependable, personalized information might improve upon this standard by priming patients for the clinical visit and allowing for more pertinent exploration of methods during the clinical visit, she notes.

Upon entering information in the web-based questionnaire, a woman receives a ranking of methods, based on her input. "Green" methods are those that are safe for her, highly effective, and those that might be a good fit with her life and health. "Yellow" methods are those that are safe for the woman, but they might not fit her situation well or might not be as effective. "Red" methods are contraindicated. The chief priority is given to safety; the algorithms are based on medical eligibility criteria from the World Health Organization (WHO), WHO's Selective Practice Guidelines, and Contraceptive Technology (Ardent Media Inc.; 2007), says Kottke.

The interactive tool has been tested in a clinical setting, says Kottke. Researchers compared use of the web site and personalized results to a generic computer survey and generic contraceptive information, with a four-month follow-up. Results are pending, she reports.

Connect with teens

Public health has been taking advantage of mobile communication devices to improve surveillance and the delivery of health interventions for some time. The National Center for Health Marketing at the Centers for Disease Control and Prevention co-sponsored the first Texting4Health conference at Stanford University in 2008. Mobile communication platforms, such as text messaging, are the next wave of public health communication and surveillance, public health officials say.3

Researchers at the Johns Hopkins University Center for Adolescent Health and the Baltimore City Health Department are looking to text messaging as part of a demonstration project designed to enhance the health department's family planning clinic's role and encourage parent involvement in adolescent contraceptive method choice and continuation.

The project, CONnecting with Teens about Contraceptive Use (CONTAC-U), is enrolling all female clients ages 20 and younger who visit the Healthy Teens & Young Adults Center in Baltimore during the 18-month project period. Project staff members provide individualized methods counseling. Automated contacts are made to each client at regular intervals beginning two weeks post-enrollment then at least monthly. The contacts highlight issues such as side effects, method use, and appointment reminders.

The heart of the intervention lies in the use of innovative technological methods, observes Kathleen Cardona, DrPH, MPH, assistant scientist in the Johns Hopkins Bloomberg School of Public Health's Population, Family, and Reproductive Health Department and the Center for Adolescent Health. Clients choose from text messaging, e-mail, and telephone as means of clinic contact. The contacts are scheduled, initiated, and recorded using a new web-based database designed for the project. This design enables the clinic to provide regular, longitudinal follow-up.

The project's web site, www.contac-u.org, employs a database with a web interface, Cardona explains. Clinic staff register clients into the system. When clients are enrolled, they inform clinicians of their preferred method of contact. Most clients have been opting for text messaging, she says.

For example, if a woman chooses to use the Pill, the first contact message would be to the effect of "have you begun taking your pills, have you had any side effects, and do you have any questions? If so, you can contact us," explains Cardona. "We actually have had people texting back, saying they had gotten the message or 'I'm OK,' which was really interesting to hear from the clinic staff," says Cardona.

Clients also can opt for reminders by text or e-mail to take their daily pill, change their patch or ring, or come in for a quarterly contraceptive injection, Cardona reports. Project designers are working on a similar interface for extended regimens, she notes.

Interest in the program from older clients has led the project to open it to women ages 20 to 24 as well, says Cardona. Targeted outcomes from the project include increasing the initiation and continued use of appropriate contraception and reducing the rate of unintended pregnancy occurring within one year of enrollment.

The Association for Reproductive Health Professionals (ARHP) has revamped its earlier "Choices" program on its web site, www.arhp.org, for a new feature, "Method Match." The interactive tool is designed to recognize women's unique birth control needs and allow them to compare contraceptive methods using criteria that are the most important to them. The tool helps women to find the method that best matches their lifestyles by sorting, filtering, and comparing up to four methods side by side.

At press time, videos featuring each birth control method were being placed on the web site, says Beth Jordan, MD, ARHP medical director. The videos will describe each method in English and Spanish. News of the web site is being disseminated through e-mails, the ARHP Facebook page, conference fliers, and advertisements in Contraception, ARHP's professional journal.

By sharing information on the Method Match tool, clinicians can help their patients stay current on contraceptive options, Jordan notes. "I'm an active clinician, and I always ask my patients, 'How is your method working for you?'" says Jordan. "This tool is a great, concise way for women to compare methods really quickly."

References

  1. Lenhart A. Teens and Social Media: An Overview. Accessed at www.pewinternet.org/Presentations.
  2. Kottke M. Using technology to improve contraceptive counseling: A web-based tool that works! Presented at the 2009 Contraceptive Technology Quest for Excellence conference. Atlanta; October 2009.
  3. Krisberg K. RU Healthy? Public health efforts take on text messaging: Campaigns adapting to new technology. Accessed at www.medscape.com/viewarticle/704350.