Through the patient's eyes: Strategies toward more successful contraception

doi:10.1016/0029-7844(96)00243-8

Obstetrics & Gynecology

Volume 88, Issue 3, Supplement 1, September 1996, Pages 41S-47S

https://doi.org/10.1016/0029-7844(96)00243-8 Get rights and content

Objective: To review the literature focusing on studies of patient satisfaction and patient involvement in the design of care and to suggest strategies for involving patients effectively in their care. While addressing issues in contraception and adherence to contraceptive regimens, we write from the perspective of general physicians who manage patients with a broad variety of problems. By learning systematically what patients want, need, and experience in health and illness, we can use such information in the redesign and improvement of care.

Data Sources: Individual anecdote, focus groups of patients, patient survey data, and a literature review were used.

Methods of Study Selection: The literature review used an English-language search of MEDLINE from 1970 to 1996, with search terms including patient satisfaction, consumer participation, patient participation, self-care, contraception, and contraceptive behavior. Previous studies conducted by the authors were also reviewed.

Tabulation, Integration, and Results: Patients report that providers who solicit patients' needs and preferences for involvement in decision making, who encourage family involvement, and who tailor educational efforts to the individual adult learning style of the patient engender greater patient satisfaction, adherence to recommended therapies, and improved patient outcomes. Recent trends in the United States, such as the growing use of alternative therapies, the self-help movement, and consumerism have influenced patient attitudes and behaviors toward seeking care and are changing their behavior. We discuss several strategies to improve patient involvement in their care, including the use of patient diaries and contracts, pre- and post-visit preparation and communication, the involvement of patients in educating providers, and the use of information technologies to enhance communication between patients and providers.

Conclusions: Patient involvement in the redesign of care may help promote greater effectiveness of contraceptive strategies.

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Cited by (35)

What matters most? The content and concordance of patients' and providers' information priorities for contraceptive decision making
2014, Contraception
Citation Excerpt :
In the United States, this is particularly salient given the significant expansions in access to contraceptive care and methods recently enabled by the Affordable Care Act [20]. Shared decision making — the process by which health care providers and patients make decisions collaboratively on the basis of evidence, clinical expertise and patient preferences [21] — is an obvious strategy to improve contraceptive decision quality and women's satisfaction with, and correct and consistent use of, their contraceptive method [19,22]. Decision support tools that provide information about available options and their salient features have potential to facilitate shared decision making [23].
The objective of this study was to identify women's and health care providers' information priorities for contraceptive decision making and counseling, respectively.
Cross-sectional surveys were administered online to convenience samples of 417 women and 188 contraceptive care providers residing in the United States. Participants were provided with a list of 34 questions related to the features of contraceptive options and rated the importance of each. Participants also ranked the questions in descending order of importance. For both women and providers, we calculated the mean importance rating for each question and the proportion that ranked each question in their three most important questions.
The average importance ratings given by women and providers were similar for 18 questions, but dissimilar for the remaining 16 questions. The question rated most important for women was “How does it work to prevent pregnancy?” whereas, for providers, “How often does a patient need to remember to use it?” and “How is it used?” were rated equally. The eight questions most frequently selected in the top three by women and/or providers were related to the safety of the method, mechanism of action, mode of use, side effects, typical- and perfect-use effectiveness, frequency of administration and when it begins to prevent pregnancy.
Although we found considerable concordance between women's and provider's information priorities, the presence of some inconsistencies highlights the importance of patient-centered contraceptive counseling and, in particular, shared contraceptive decision making.
This study provides insights into the information priorities of women for their contraceptive decision making and health care providers for contraceptive counseling. These insights are critical both to inform the development of decision support tools for implementation in contraceptive care and to guide the delivery of patient-centered care.
Entropy in good manufacturing system: Tool for quality assurance
2011, European Journal of Operational Research
Citation Excerpt :
For research and practical application, information regarding each of GMP sub-parameter’s implementation patterns in specific section of the health care organization like contraceptive manufacturing organization would be of considerable value (Checkland, 1993; Bohn, 1994; Bongaarts and Bruce, 1995; Costello et al., 2001; Green, 2008). For example, in the process of achieving quality by parameter design above information would help in the correlation of product performance and customer satisfaction with the specific process design in the organization (Saraph et al., 1989; Thomas and Daley, 1996; Jha et al., 2010a). Simultaneously, this detailed and specific knowledge of each of GMP parameter’s individual contribution pattern to the product of interest would help in case of cost reduction of health care products, improvement of internal efficiency as well as, for competitive advantage of organization by setting of ideal process design and resource allocation for total utilization (Mandelbaum, 1990; Neuman et al., 1993; Flynn et al., 1994; Wiendahl and Scholtissek, 1994; Kelld and Sonnleitner, 1995; Bunney and Dale, 1996; Upton, 1996).
It has been customary to implement Good Manufacturing Practices (GMP) in pharmaceutical organizations as a systematic and comprehensive quality approach and sometimes by regulatory enforcement. In this scenario, determination of the obvious entropy/disorder arising during the implementation has not been taken care of yet. Therefore, this paper gives the basis for applying query and visual perception of GMP system driven visualization approach, particularly the Laplace equation, to the determination of disorder and deviation pattern inside the GMP system applied in the organization. In this study, a three-dimensional mesh approached with raw and intermediate input handled under GMP parameter is considered to produce high quality products with minimum entropy (variation distribution) by adding the analogy wise different GMP parameters and process variables with Gauss Seidel iteration and thus producing visual picture of the entire system. The approximation involved in applying the equations to the GMP compliant aseptic region was analyzed. Using numerical technique and computer program, the Gauss Seidel iteration equations have been solved with appropriate GMP parameter and process variable. The result indicates that deviations vary over the GMP compliant system and that the process entropy affects the totality of disorderness. Experiments with model of GMP compliant reproductive medicine laboratory confirm that the new method provides optimal manufacturing maintaining GMP and high product quality through the visual representation of the entire system and activity to bring into notice the deviations.
Towards client-centered counseling: Development and testing of the WHO Decision-Making Tool
2010, Patient Education and Counseling
To describe development and testing of a counseling tool intended to inform family planning clients while helping the family planning provider facilitate the client's decision-making process; and to discuss challenges and requisites for shifting to shared decision-making from the extremes of decision-making dominated by the provider, on one hand, or unaided by the provider, on the other.
The WHO Decision-Making Tool for Family Planning Clients and Providers is derived from evidence-based principles of client-centered care and counseling. This article discusses how these principles are manifested in the Tool and how the Tool aids both provider and client in improving counseling.
Development of the Tool involved formative workshops with providers in Indonesia, Mexico, South Africa and Trinidad and Tobago and observational evaluation research in Indonesia, Mexico, and Nicaragua. Analysis of videotaped counseling sessions quantitatively assessed client–provider communication and decision-making. Also, focus-group discussions, interviews, and a questionnaire collected qualitative data from providers and clients.
In general, use of the Tool improved providers’ counseling performance: they engaged clients more and gave more and better tailored information. For clients, the Tool increased their communication and involvement. Both the Nicaraguan and Mexican studies found marked shifts toward the client in the locus of decision-making after introduction of the Tool.
Use of the tool improves the performance of both providers and clients in family planning counseling and decision-making. There are challenges, however, at the levels of both the provider and the organization in sustaining these changes and scaling up such initiatives in quality of care.
A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the human immunodeficiency virus
2007, American Journal of Obstetrics and Gynecology
Citation Excerpt :
When these women are included in the overall switching comparison, the effect is attenuated considerably (hazard for switching from hormonal contraceptives compared with the IUD, 0.6; 95% CI, 0.46-0.78). Taken together, these data confirm, in HIV-infected women, what is already known about contraception in the general population: that women change contraceptive methods frequently17 and that the most important component of good contraceptive public health is availability of method choice.18 We believe this study demonstrates that, although the IUD may not be acceptable to all women, it certainly should figure prominently in the portfolio of contraceptive options that are available to HIV-infected women.
The purpose of this study was to determine whether the intrauterine contraceptive device (IUD) is effective and safe among women who are infected with the human immunodeficiency virus (HIV).
We randomly assigned 599 postpartum, HIV-infected women in Zambia to receive either a copper IUD or hormonal contraception and followed them for at least 2 years.
Women who were assigned randomly to hormonal contraception were more likely to become pregnant than those who were assigned randomly to receive an IUD (rate, 4.6/100 vs 2.0/100 woman-years; hazards ratio, 2.4; 95% CI, 1.3-4.7). One woman who was assigned to the IUD experienced pelvic inflammatory disease (crude rate, 0.16/100 woman-years; 95% CI, 0.004-868); there was no pelvic inflammatory disease among those women who were assigned to hormonal contraception. Clinical disease progression (death or CD4+ lymphocyte count dropping below 200 cells/μL) was more common in women who were allocated to hormonal contraception (13.2/100 woman-years) than in women who were allocated to the IUD (8.6/100 woman-years; hazard ratio, 1.5; 95% CI, 1.04-2.1).
The IUD is effective and safe in HIV-infected women. The unexpected observation that hormonal contraception was associated with more rapid HIV disease progression requires urgent further study.
How do the accounts of the patients on pregnancy and birth process enlighten medical team in terms of narrative ethics?
2006, Patient Education and Counseling
The aim of this study is to evaluate the relationship between the patient and the physician, midwife and nurse during the process of pregnancy and birth, and to ascertain the importance of communication within this relationship; find out the experiences of patients about the communication process.
Three hundred eighty-eight people were interviewed about the pregnancy and birth process. Chi square (χ²) and t-tests were used for the statistical evaluation of the data. Forty-nine pregnant women, who were participating in any pregnancy training program, were asked to write down their experiences related to the pregnancy and birth process in a notebook. Thirty-two (65.3%) of these notebooks were taken back 3 months after the delivery, and these notebooks were evaluated within the framework of “narrative ethics” and common themes were found out in order to be discussed in this paper.
It is found out that communication skills of doctors and midwives/nurses were of primary importance for all the participants.
Pregnancy and birth are special processes and being informed is of great importance in this process. Every woman has a story to tell about her pregnancy and birth processes.
These findings may contribute to the development of new hypotheses. Hence, similar research projects should be conducted, and the findings should be compared.
Acceptability as a key determinant of client satisfaction: lessons from an evaluation of adolescent friendly health services in Mongolia
2006, Journal of Adolescent Health
The primary focus of this study is to investigate which characteristics of health service quality are most likely to determine client satisfaction with health services among adolescents in Mongolia.
Data were gathered from 1301 male and female clients. Exit interviews were used to measure client satisfaction; 82 clinics were visited. All clients between the ages of 10 and 19 years were asked to participate in the client exit interview; those who agreed to participate completed the questionnaire. Bivariate and multivariate analyses were conducted to determine significant associations between service satisfaction and the independent variables. All variables showing a significant bivariate association with service satisfaction (p ≤ .05) were retained for logistic regression analyses.
The strongest determinant to client satisfaction related to acceptability: adequate facility physical environment, receiving adequate information about the facility, and if the facility was private (i.e., other people didn’t know the services the client received). Additionally, clients who said they received some interruptions, either by other health workers or clients, were significantly less likely to be satisfied with the services.
This study demonstrates the importance of understanding and measuring different aspects of health service quality in defining client satisfaction. Although both accessibility and acceptability of services have been shown to be important in other studies, characteristics relating to acceptability emerged as critical in determining client satisfaction among adolescents in Mongolia. Efforts to improve health service delivery to adolescents need to understand and address the “adolescent friendly” characteristics that are most salient, and least fulfilled, in each particular context.

View all citing articles on Scopus

: This work was supported in part by the Commonwealth Fund of New York.

: Presented in part at the Conference on Contraceptive Use, Kaiser Family Foundation, National Institute of Child Health and Human Development, October 5–6, 1995, Bethesda, Maryland.

^a: Dr. Daley is a Senior Research Associate in the Department of Veterans Affairs Health Services Research and Development Career Development Award Program.

View full text

Through the patient's eyes: Strategies toward more successful contraception

Am J Med

Am J Med Sci

J Pediatr

Am J Med

How well do women comply with oral contraceptive regimens?

Fam Plann Perspect

Why some women fail to use their contraceptive method: A psychological investigation

Fam Plann Perspect

Medical patients' assessments of their care during hospitalization

J Gen Intern Med

Measuring patients' desire for autonomy: Decision making and information-seeking preferences among medical patients

J Gen Intern Med

Do patients want to participate in medical decision making?

JAMA

An introduction to medical phenomenology: I can't hear you while I'm listening

Ann Intern Med

Enriching the doctor-patient relationship by inviting the patient's perspective

Ann Intern Med

The relationship of physician medical interview style to patient satisfaction

J Fam Pract

Verbal communication skills and patient satisfaction: A study of doctor-patient interviews

Eval Health Prof