Paula M. Castaño

Effect of daily text messages on oral contraceptive continuation: a randomized controlled trial.

OBJECTIVE: To estimate whether daily educational text messages affect oral contraceptive pill (OCP) continuation at 6 months. METHODS: We randomized young women electing OCPs at an urban family planning health center to either routine care or routine care plus 180 days of daily educational text messages. Investigators masked to treatment allocation randomized participants who were not masked to treatment. The primary outcome measure was self-reported OCP continuation through a telephone call at 6 months (contacts between 5 and 8 months). RESULTS: We enrolled 962 participants (480 intervention and 482 routine care) and obtained continuation data on 683 (346 and 337, respectively). At the follow-up, 64% of participants randomized to the intervention were still OCP users compared with 54% of the routine care group (P=.005). Continuation was highest in the intervention group if the interview took place while the intervention was ongoing (75% compared with 54%, P=.003); the effect of the intervention on continuation was less after the intervention ended (60% compared with 54%, P=.16). Participants receiving the intervention were more likely to continue oral contraception than control participants at 6 months (odds ratio 1.44, 95% confidence interval 1.03–2.00) in analyses adjusted for age, race or ethnicity, age at coitarche, pregnancy history, and OCP experience. CONCLUSION: The use of daily educational text messages improves OCP continuation at 6 months over routine care alone. Ten women would need to receive this simple intervention to improve continuation in one. This effect is strongest in the women whose follow-up took place while the text intervention was ongoing. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.ClinicalTrials.gov, NCT00677703. LEVEL OF EVIDENCE: I

Oral Contraceptives and Libido in Women

Abstract Oral contraceptives (OCs) provide safe, effective, and reversible contraception and are widely used by women for fertility control. Little is known about the effects of OCs on sexual functioning. This paper critically examines the published literature addressing the impact of OCs on sexual desire or libido. We reviewed 30 original research studies. In the retrospective, uncontrolled studies (n = 17), it was found that most women reported an increase in libido during OC use. In the uncontrolled, prospective studies (n = 4), it was found that most women reported little change in libido during OC use. In the prospective and cross-sectional controlled studies (n = 4), women using OCs reported both increased and decreased libido compared to non-OC users. The findings from randomized, placebo-controlled studies (n = 5) were mixed: In the most recent and well-conducted trial, a decrease in libido in OC users compared to placebo users was found. Overall, women experience positive effects, negative effects, as well as no effect on libido during OC use. Better-designed studies are needed to establish the independent, causal effects of OCs on libido.

Influenza Vaccine Text Message Reminders for Urban, Low-Income Pregnant Women: A Randomized Controlled Trial

OBJECTIVES We evaluated the impact of influenza vaccine text message reminders in a low-income obstetric population. METHODS We conducted a randomized controlled trial that enrolled 1187 obstetric patients from 5 community-based clinics in New York City. The intervention group received 5 weekly text messages regarding influenza vaccination starting mid-September 2011 and 2 text message appointment reminders. Both groups received standard automated telephone appointment reminders. The prespecified endpoints were receipt of either pre- or postpartum influenza vaccination calculated cumulatively at the end of each month (September-December 2011). RESULTS After adjusting for gestational age and number of clinic visits, women who received the intervention were 30% more likely to be vaccinated as of December 2011 (adjusted odds ratio [AOR] = 1.30; 95% confidence interval [CI] = 1.003, 1.69 end of September: AOR = 1.34; 95% CI = 0.98, 1.85; October: AOR = 1.35; 95% CI = 1.05, 1.75; November: AOR = 1.27; 95% CI = 0.98, 1.65). The subgroup of women early in the third trimester at randomization showed the greatest intervention effect (December 31: 61.9% intervention vs 49.0% control; AOR = 1.88; 95% CI = 1.12, 3.15). CONCLUSIONS In this low-income obstetric population, text messaging was associated with increased influenza vaccination, especially in those who received messages early in their third trimester.

Exploring pregnant women's views on influenza vaccination and educational text messages

BACKGROUND The influenza vaccine has the potential to reduce morbidity among pregnant women and newborns but immunization coverage remains low. Effective interventions are needed to promote vaccine uptake in this population. PURPOSE The goal of this study was to explore attitudes toward influenza vaccination and interest in targeted educational text messages among urban pregnant women. METHODS English and Spanish language focus groups were conducted with pregnant women in New York City in April 2010. Transcripts were independently coded using content analysis. RESULTS The 40 participants ranged in age from 19-35 years (mean=26, SD=5). Their gestational age ranged from 8-40 weeks (mean=27, SD=8). Most were Latina (85%), had other children (70%), and were publicly insured (78%). Nearly half had received the seasonal influenza or influenza A (H1N1) 2009 monovalent vaccine. Barriers to vaccination included concerns regarding vaccine safety and efficacy, misperceptions regarding risks for influenza, and lack of provider recommendation. Pregnant women expressed interest in receiving educational text messages regarding influenza. Even women who had refused the influenza vaccine thought the text messages would encourage vaccine-related discussions during prenatal visits. CONCLUSION Among urban pregnant women, educational text messages regarding influenza would be well received and may effectively address current barriers to vaccination.

The impact of an educational text message intervention on young urban women's knowledge of oral contraception

BACKGROUND Oral contraceptive (OC) knowledge deficits may contribute to OC discontinuation. We examined the effect of an innovative educational intervention on young womens OC knowledge. STUDY DESIGN As part of a randomized trial evaluating the impact of text message reminders on OC continuation, we assessed OC knowledge in 659 women ages 13-25 years. Women received routine care or routine care plus 6 months of daily educational text messages. We administered a comprehensive 41-item OC knowledge survey at baseline and 6 months. RESULTS Mean OC knowledge scores improved over time for all women (baseline 22.8, 56% correct versus 24.7, 60% at 6 months), including knowledge of OCs mechanisms of action (p=.004), effectiveness (p<.001), side effects (p=.03) and benefits (p<.001). Mean 6-month scores were greater in the intervention (25.5) than the control group (23.7)(p<.001). In multivariable linear regression models, the text message intervention most strongly predicted OC knowledge (β=1.6, 95% confidence interval 0.9-2.2). CONCLUSION Daily educational text messages can modestly improve knowledge of OCs, which may promote successful contraceptive outcomes.

Barriers to and enablers of contraceptive use among adolescent females and their interest in an emergency department based intervention

OBJECTIVE Over 15 million adolescents, many at high risk for pregnancy, use emergency departments (EDs) in the United States annually, but little is known regarding reasons for failure to use contraceptives in this population. The purpose of this study was to identify the barriers to and enablers of contraceptive use among adolescent females using the ED and determine their interest in an ED-based pregnancy prevention intervention. STUDY DESIGN We conducted semistructured, open-ended interviews with females in an urban ED. Eligible females were 14-19 years old, sexually active, presenting for reproductive health complaints and at risk for pregnancy, defined as nonuse of effective (per the World Health Organization) contraception. Interviews were recorded, transcribed and coded based on thematic analysis. Enrollment continued until no new themes emerged. A modified Health Belief Model guided the organization of the data. RESULTS Participants (n=14) were predominantly Hispanic (93%), insured (93%) and in a sexual relationship (86%). The primary barrier to contraceptive use was perceived health risk, including effects on menstruation, weight and future fertility. Other barriers consisted of mistrust in contraceptives, ambivalent pregnancy intentions, uncertainty about the future, partners desire for pregnancy and limited access to contraceptives. Enablers of past contraceptive use included the presence of a school-based health clinic and clear plans for the future. All participants were receptive to ED-based pregnancy prevention interventions. CONCLUSIONS The identified barriers and enablers influencing hormonal contraceptive use can be used to inform the design of future ED-based adolescent pregnancy prevention interventions. IMPLICATIONS Adolescents who visit the emergency department (ED) identify contraceptive side effects, mistrust in contraceptives, limited access, pregnancy ambivalence and partner pregnancy desires as barriers to hormonal contraception use. They expressed interest in an ED-based intervention to prevent adolescent pregnancy; such an intervention could target these themes to maximize effectiveness.

Music as an auxiliary analgesic during first trimester surgical abortion: a randomized controlled trial

BACKGROUND Music has served as an auxiliary analgesic in perioperative settings. This study evaluates the impact of intraoperative music added to routine pain control measures during first trimester surgical abortion. STUDY DESIGN We analyzed data from 101 women randomized to undergo abortion with routine pain control measures only (ibuprofen and paracervical block) or with the addition of intraoperative music via headphones. The primary outcome was the change in preoperative and postoperative pain scores on a 100-mm visual analog scale. Secondary outcomes included change in anxiety and vital signs, and satisfaction. RESULTS Baseline characteristics were similar between groups. The magnitude of increase in pain scores was greater in the intervention than in the control group (+51.0 mm versus +39.3 mm, p=.045). Overall pain control was rated as good or very good by 70% of the intervention and 75% of the control group (p=.65). CONCLUSIONS Intraoperative music added to routine pain control measures increases pain reported during abortion.

Evaluation of Smartphone Menstrual Cycle Tracking Applications Using an Adapted APPLICATIONS Scoring System.

OBJECTIVE: To identify smartphone menstrual cycle tracking applications (apps) and evaluate their accuracy, features, and functionality. METHODS: In this systematic evaluation, we searched the Apple iTunes store for free menstrual cycle tracking apps for patient use. We considered an application accurate if menstrual cycle predictions were based on average cycle lengths of at least three previous cycles, ovulation (when included) was predicted at 13–15 days before the start of the next cycle, and the application contained no misinformation. We modified the APPLICATIONS Scoring System to evaluate the features and functionality of accurate apps. RESULTS: Our search criteria yielded 1,116 apps; 108 remained after excluding duplicate, non-English, nonmenstrual cycle tracking, and priced apps. We further eliminated 88 that did not meet inclusion or accuracy criteria. Of the 20 accurate, free apps, 80% contained information for conception and 50% for contraception. Common features and functionality included password protection (55%); no requirement for Internet connectivity (80%); no advertisements (65%); in-application technical support (70%); medical disclaimers (65%); health education (55%); tracking of menstrual flow (70%), symptoms (70%), and intercourse (75%); alerts for next menses (65%) and fertility (55%); and cycle length information (75%). Forty percent were available for Android. Usefulness for fertility medications (15%), professional involvement (5%), and cited literature (5%) were rare. CONCLUSION: Most free smartphone menstrual cycle tracking apps for patient use are inaccurate. Few cite medical literature or health professional involvement. We list accurate apps to aid health care providers in understanding the key components they can use to evaluate and recommend apps for patients.

Using digital technologies to improve treatment adherence.

Although health care recommendations should be agreed upon by a patient and her provider, patients cannot always follow these recommendations. Adherence remains low despite decades of research, highlighting the need for innovative approaches to tackle this problem. Interventions to improve adherence can capitalize on our reliance on technology. Digital technology interventions show promise in aiding patients attain and maintain their health care goals, including adherence to medication regimens and vaccination recommendations, receiving necessary treatment, attending appointments, and maintaining healthy behaviors. We present suggestions for clinicians who want to incorporate technologies to help their patients better engage in their health care.

The Influence of Oral Contraceptive Knowledge on Oral Contraceptive Continuation Among Young Women

BACKGROUND Using a multidimensional approach, we assessed young womens knowledge of oral contraceptives (OC) and its influence on OC continuation rates. METHODS We used data from 659 women aged 13-25 years participating in a randomized controlled trial of an educational text message OC continuation intervention. Women received 6 months of daily text messages or routine care. At baseline and 6 months, we administered a comprehensive 41-item questionnaire measuring knowledge of OCs mechanism, effectiveness, use, side effects, risks, and benefits. We ascertained OC continuation status and reasons for discontinuation at 6 months. We analyzed relationships between OC knowledge and continuation with multivariable logistic regression. RESULTS Young women scored, on average, 22.8 out of 41 points on the OC knowledge assessment at baseline and 24.7 points at 6 months. The 6-month OC continuation rate was 59%. OC continuers had >2-points-higher OC knowledge scores at 6 months than discontinuers (p<0.001). Those who reported discontinuing their OCs for side effects and forgetfulness scored >2 points lower than women who discontinued for other reasons (p-values<0.001). In multivariable regression models, each correct response on the baseline and 6-month knowledge assessments was associated with a 4% and 6% increased odds of OC continuation, respectively. Six-month OC knowledge scores were negatively associated with OC discontinuation due to side effects (odds ratio [OR] 0.94) and forgetfulness (OR 0.88). CONCLUSIONS OC knowledge, which was low among young women in our study, was associated with OC continuation and common reasons for discontinuation. Continued efforts to characterize relationships between OC knowledge and behavior and to test the effectiveness of different components of interventions aimed at increasing knowledge, addressing side effects, and improving use of OCs are warranted.