Comprehensive counseling about combined hormonal contraceptives changes the choice of contraceptive methods: results of the CHOICE program in Sweden

Objective: To study the influence of counseling on women's contraceptive decisions.

Design: A cross-sectional multicenter study.

Setting: Seventy Swedish family planning clinics.

Population: Women aged 15-40 years attending for a contraceptive consultation who expressed interest in a combined hormonal contraceptive (CHC) method.

Methods: Structured counseling about three CHCs and questionnaires completed after counseling from the healthcare professional.

Main outcome measures: Method originally requested, perceptions of CHC attributes, method chosen and reasons for the choice.

Results: In all, 173 healthcare professionals and 1,944 women participated. The mean standard deviation (SD) age of the women was 22.6(6.1) years. After structured counseling, a majority of women (56.0%; n=1 069; 95% confidence interval (CI) 53.1-58.9) chose the daily pill, 6.2% (n=118; 95% CI 4.9-7.8) chose the weekly patch, and 22.5% (n=430; 95% CI 20.2-25.1) chose the monthly ring. The weekly patch was chosen more often after counseling (6.2 vs 2.4% before counseling; p<0.0001). The greatest change was in the proportion of women who chose the contraceptive ring after counseling (22.5% vs. 8.5% before counseling; p<0.0001). The proportion of undecided women after counseling was reduced considerably (3.9% vs. 27.8% before counseling). Among the 523 women who were undecided before counseling, 50.6% chose the pill, 10.2% the patch and 24.6% the ring, while 20.9% of women who initially requested the pill changed to another method.

Conclusions: Structured counseling facilitated choice of contraceptive method for most women, leading to changes in women's selection of a CHC method.