A study of two interventions to increase adherence with oral contraceptives and condom use among adolescents and young adults
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A randomized, controlled trial was conducted to examine the effectiveness of two different interventions on adherence with oral contraception (OC) and their effect on dual use (oral contraception and condoms). A total of 1,155 women 16-24 years of age who requested oral contraception at one of five reproductive health clinics were recruited to participate and randomized to receive either (1) face-to-face behavioral counseling and education at their baseline clinic visit (C group); (2) this same intervention followed by monthly phone calls for 6 months (C+P group); or (3) standard care (S group). Phone interviews at 3, 6, and 12 months after the initial visit assessed whether women developed a cue (defined as use of an object or action to help them remember to take their medication), duration and correctness of contraceptive use, method satisfaction, clinic follow up, condom use with and without hormonal contraceptive use (dual use), and rates of pregnancy and sexually transmitted infections (STIs). Bivariate analysis demonstrated that women in the C+P group were more likely to use their pills correctly in only one out of the 12 months of follow up. Analysis using General Estimating Equations showed that those in the C group were actually more likely to switch brands of OC and less likely to recommend their method to a friend. Those randomized to C+P were more likely to report condom use at last intercourse, but not more likely to use condoms while taking OC. Furthermore, use of a cue was associated with a longer period of correct OC use, regardless of the intervention. No differences were observed between those in either intervention group and standard care in contraceptive discontinuation, satisfaction rates, correct use of their method, or STI rates. Finally, the Mantel Haenszel test revealed no differences in pregnancy rates between groups during the 12 months of follow up. In conclusion, this study demonstrated that clinic based education with or without phone follow up is not effective in helping young women use OC for a longer duration or more accurately. Furthermore, it does not increase rates of dual use.