Feasibility of a self-completed history questionnaire in women requesting repeat combined hormonal contraception.
ABSTRACT To measure agreement between the client's and the clinician's responses to questions regarding client history as answered on a questionnaire based on the UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) for combined hormonal contraception (CHC).
Clients aged 18 years and over, attending a central London community contraceptive clinic requesting a repeat supply of CHC, completed a history questionnaire and an evaluation form. Clinicians then completed their copy of the same questionnaire during the consultation. Percentage agreement and the Kappa statistic were used to assess the level of client-clinician agreement.
Data from 328 client-clinician pairs were analysed. Agreement was above 93% for all identified risk factors. There was complete agreement for thrombosis, diabetes, stroke, cancer and liver problems. Least agreement was noted in the recording of migraine and abnormal bleeding. For all risk factors except smoking, the proportion of clients reporting a risk factor was more than the proportion of clinicians reporting a risk factor. No clinically important information relevant to a particular client's use of CHC was missed and none of them would have been wrongly prescribed the CHC based just on their self-completed questionnaires. Most women (97%) were happy with this method of history taking.
A self-completed history questionnaire is acceptable to women and can potentially replace traditional routine medical history taking for continuing CHC. Women completed the questionnaire with a high degree of reliability. There was complete client-clinician agreement on UKMEC Category 4 criteria. Overall, clients reported more risk factors than clinicians, which increases the safety of the questionnaire.
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ABSTRACT: The objective of this study was to report user statistics of an online contraception selection tool over a 6-month period, comparing preferences and characteristics of adolescents to those of adults. Choosing Wisely, available on the website www.SexualityandU.ca, is an interactive program that helps women select an ideal birth control method. Answers to the online questionnaire were logged for a 6-month period. Answers of adolescent users were retrospectively reviewed for responses to questions regarding personal preferences and compared with those of adults. Participants of the study included users who self-identified as first-time users of Choosing Wisely. 3178 adolescents (age ≤19) and 4206 adults self-identified as new users and completed the software module. Adolescents less commonly reported weighing over 198 pounds or to be smokers. 61% of adolescents would prefer to avoid menses (vs 52% of adults) and 83% of adolescent would find a pregnancy devastating (vs 64% of adults). 1720 (54%) of the adolescents had menstrual complaints; of these 500 (29%) did not believe they could reliably take a pill daily. The majority of both adolescents (73%) and adults (71%) claimed to be willing to use a contraceptive method that required interruption of intercourse. Choosing Wisely is attracting large numbers of teens and adults, whose responses provide insight into the characteristics of those seeking contraception. Our data corroborate the need for contraceptive options such as combined contraceptives that do not require daily pill-taking and contraceptives that offer menstrual management. However, the magnitude of these statistically significant differences was not always as impressive clinically.Journal of pediatric and adolescent gynecology 10/2011; 24(5):317-9. DOI:10.1016/j.jpag.2011.06.002 · 0.90 Impact Factor
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ABSTRACT: To describe client experience of self-management within a busy walk-in, sexual health service. Self-management in this context is self-registration and take-home pregnancy tests, chlamydia (Chlamydia trachomatis) and gonorrhoea (Neisseria gonorrhoeae) tests, or condoms dispensed from a free vending machine. Twenty-four in-depth, semi-structured interviews with users; 19 structured written reports from mystery shoppers paid to visit the service and report their experience; demographic details of those using the self-management option from the clinic database and 40 h of recorded observation in the clinic waiting room. Between 2 September 2008 and 1 September 2009, 18 657 people had 28 545 attendances at the service. Of these, 1845 (6.5%) attendances were self-managed by 1555 individuals (8.3% of all clients). Of those who self-managed, 646 (35%) obtained a chlamydia and gonorrhoea test only, 597 (32%) obtained condoms only and 488 (27%) obtained a pregnancy test only. Users valued the opportunity to self-manage because of the reduced waiting times, autonomy and privacy that such a service offers. Some prefer the additional support offered within a clinical consultation. Users made personalised decisions about self-management based on time pressure, need for additional services and preferred source of support. Users often required help and advice from client support workers to complete the self-management process. This created problems with confidentiality. Self-management is an acceptable option within sexual health services if informal support is available. Self-management options in clinical services could mean that 8% of clients at 6% of visits do not need to see a clinician, thus freeing up clinical capacity.Sexual Health 02/2011; 8(1):23-9. DOI:10.1071/SH10029 · 1.58 Impact Factor
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ABSTRACT: To estimate the accuracy of self-screening for contraindications to combined oral contraceptive pills (COCs) and to estimate the proportion of women with contraindications to hormonal methods among those using drug shops in Tanzania. Trained nurses interviewed 1651 women aged 18-39years who self-screened for contraindications to COCs with the help of a poster at drug shops in Tanzania. Nurse assessment of the women served as the gold standard for comparison with self-assessment. Blood pressure was also measured onsite. Nurses reported that 437 (26.5%) women were not eligible to use COCs, compared with 485 (29.4%) according to self-report. Overall, 133 (8.1%) women who said that they were eligible were deemed ineligible by nurses. The rate of ineligibility was artificially high owing to participant and nurse assessments that were incorrectly based on adverse effects of pill use and cultural reasons, and because of the sampling procedure, which intercepted women regardless of their reasons for visiting the drug shop. Adjusted rates of ineligibility were 8.6% and 12.7%, respectively, according to nurse and participant assessment. Both nurses and women underestimated the prevalence of hypertension in the present group. Self-screening among women in rural and peri-urban Tanzania with regard to contraindications to COC use was comparable to assessment by trained nurses.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 07/2013; 123(1). DOI:10.1016/j.ijgo.2013.04.024 · 1.41 Impact Factor