Pregnancy and STD Prevention Counseling Using an Adaptation of Motivational Interviewing: A Randomized Control Trial
Contraception use among use women at risk for unintended pregnancy increases 2 months after they were involved in a pregnancy prevention counseling intervention, but program effects diminish at 12 months.
Many unintended pregnancies are caused by nonuse or inconsistent use of contraceptives, which also exposes women to a higher risk of contracting sexually transmitted diseases (STDs). Simple strategies like pregnancy and STD prevention counseling can have a huge effect on the consistent and correct use of contraceptives. Yet, because few such interventions have been implemented, there is a lack of standardized and proven counseling interventions to reduce unintended pregnancies and prevent STDs. This study examines the effect of STD and pregnancy prevention counseling on pregnancy and STD rates for women in North Carolina. The intervention provided pregnancy and STD prevention counseling with general health education (including topics such as healthy living, substance abuse, and exercise), at enrollment and two months later in a booster session to women at risk of unintended pregnancy, defined as not currently pregnant, not intending to become pregnant within the upcoming year, and not using an IUD. The control group received brief, general counseling at enrollment on preventative health care (smoking, diet, exercise) and no counseling on pregnancy and STD prevention.
Although women in the intervention group were more likely to use contraceptives after two months, there were no significant differences between intervention and control groups after 12 months.
- Initially, 57% of participants reported barriers to contraceptive use, including forgetfulness (28%), side effects (19%), being too sexually aroused (15%), alcohol usage (13%), and partner opposition (12%).
- 59% of all participants also reported a high level of contraceptive use (using a contraceptive every day or condoms every time), 19% a low level, and 22% nonuse.
- At two months, high contraceptive use increased to 72% for the intervention group, compared to 66% for the control group, although this value was not statistically significant. At twelve months follow-up, 64% of participants in the intervention maintained a high level of contraceptive use, compared to 60% in the control group.
- After two months, 72% of black women in the intervention group reported improving their contraceptive use or maintaining a high level of use, as opposed to only 55% of black women in the control group. This difference diminishes at 12 months, however, because only 60% of black women in the intervention group maintained or improved a high level of use, compared with 54% in the control group.
- After 12 months, there were no effects from the intervention or significant differences between the group that received the pregnancy and STD prevention counseling and the group that received the general health counseling.
In short, pregnancy and STD prevention and general health counseling improved contraceptive use among women at risk of unintended pregnancy in the short term. However, repeated counseling or booster sessions may be necessary to maintain the results over the long-term.
The study was conducted between March 2003 and September 2004 at three primary care facilities associated with the University of North Carolina at Chapel Hill. Researchers randomly assigned 764 women aged 16-44 at risk of unintended pregnancy to either receive pregnancy and STD prevention counseling (the intervention group) or only general health counseling (the control group). The intervention group received STD prevention counseling with general health education (including topics such as healthy living, substance abuse, and exercise) at enrollment and two months later in a booster session. The control group received brief, general counseling at enrollment on preventative health care (smoking, diet, exercise) and no counseling on pregnancy and STD prevention. The intervention was based on motivational interviewing, which involved exploring discrepancies between intentions and actions, sharing information, and promoting behaviors to reduce risk.
Participants received counseling at sessions during enrollment and two months later. Participants completed questionnaires about preventive health, contraceptive use, pregnancy intentions and STD occurrence at baseline and at two, eight and twelve months after enrollment. At the twelve-month follow-up, participants were tested for chlamydia and their medical records were examined to assess documentation of a pregnancy or diagnosis and treatment of STDs during the study period. Women in both groups were compensated $25 at the end of their participation.