Objective: To assess whether provision of educational leaflets or questions on contraception improves knowledge of contraception in women taking the combined contraceptive pill.
Design: Randomisation of women into three groups according to type of educational leaflet on contraceptive information. These groups were subdivided into two on the basis of questions on contraception asked by the doctor or practice nurse. The women were followed up by postal questionnaire 3 months later.
Setting: 15 general practices in South and West region.
Subjects: 636 women attending check up appointment for repeat prescription of the combined contraceptive pill.
Main outcome measures: Knowledge of: factors causing pill failure, subsequent action, emergency contraception, and all the rules (pill rules) that apply to the contraceptive pill.
Results: 523 women returned completed questionnaires (response rate 82%). Knowledge of contraception with no intervention was low with only 10 (12%) women knowing all the pill rules. Educational intervention had a highly significant effect on knowledge of: factors causing pill failure (likelihood ratio chi2=22); subsequent action (21); emergency contraception (24); and all the pill rules (22) (P<0.01 in all cases). Improvement in knowledge of all the pill rules occurred with provision of the summary leaflet (28% knew all the rules, adjusted odds ratio 4.04, 95% confidence interval 1.68 to 9.75), the Family Planning Association's leaflet (27%, 3.43, 1.45 to 8.09), and asking questions (26%, 3.03, 1.30 to 7.00). Asking questions in addition to provision of leaflets improved knowledge of contraception further for the summary leaflet (39%, 6.81, 2.85 to 16.27) but not for the Family Planning Association leaflet (21%, 2.58, 1.07 to 6.18).
Conclusion: Women attending check ups for repeat prescriptions of the contraceptive pill should be provided with educational leaflets on contraception or asked relevant questions to help improve their knowledge of contraception. Asking questions in addition to providing a summary leaflet is time consuming, but results in the most knowledge gained.
PIP: Inadequate knowledge about combined oral contraceptives (OCs) is a major contributor to method failure. The impact of provision of two types of educational leaflets on contraception and/or a questions-and-answers exchange with a family planning provider on contraceptive knowledge was compared in a study conducted in 15 general practices in England's South and West region. Enrolled were 523 women 18-45 years of age who presented in a 6-month period in 1996 for repeat prescription of combined OC. These women were randomly assigned to receive either a card summarizing 12 basic rules of OC taking, a more comprehensive fact sheet prepared by the British Family Planning Association (FPA), a set of interactive questions on OCs and education from the provider if women gave a wrong answer, or a combination of printed material and questions. Singly, all three interventions produced modest improvements in knowledge of factors causing OC failure, emergency contraception, and general rules of OC taking. The odds ratio of knowing all the OC-related rules at follow-up, adjusted for other knowledge predictors, was 4.04 (95% confidence interval (CI), 1.68-9.75) for the summary card, 3.43 (95% CI, 1.45-8.09) for the FPA leaflet, 3.03 (95% CI, 1.30-7.00) for the interactive questions, 6.81 (95% CI, 2.85-16.27) for the summary card plus questions, and 2.58 (95% CI, 1.07-6.18) for the FPA leaflet plus questions. The largest effect on knowledge of contraception was recorded among women who received both the summary card and were asked questions.