Daily pill-taking routine important.

In various developed countries, lack of a daily pill-taking routine and lack of client knowledge about correct oral contraceptive (OC) use contribute to nonadherence to pill-taking regimens, research has shown.

The findings suggest that providers can play an important role in increasing OC adherence by helping clients establish a daily pill-taking routine, understand the instructions for OC use, and identify where to obtain further OC information should a problem or question arise. The need to improve OC adherence is clear: It has been estimated that nonadherence to OC regimens contributes to 15 percent of the more than one million unplanned pregnancies occurring each year in the United States alone. (1)

To determine variables associated with lack of OC adherence, researchers from Health Decisions, Inc., and the University of North Carolina, Chapel Hill, North Carolina, USA, conducted a survey in urban Denmark, France, Italy, Portugal, and the United Kingdom among some 6,500 women who had ever used OCs. (2) From 1995 to 1996, researchers from these institutions and Planned Parenthood Federation of America, New York, NY, USA, also delivered questionnaires (in part to identify characteristics affecting consistency of OC use) to nearly 1,000 U.S. women who were initiating OCs or switching from another method to OCs. (3) In both studies, the strongest predictor of OC nonadherence was lack of a daily pill-taking routine: Those women who did not have an established routine were three to five times more likely to miss pills than were those who had such a routine. The studies also found that women who understood little or none of the written information that came with their OC packages were at least twice as likely to use their pills inconsistently as were those who completely understood the instructions. Other factors that predicted OC non-adherence (though not as strongly) included dissatisfaction with counseling about OCs and the presence of side effects such as hair growth, breast tenderness, nausea, and bleeding problems.

The researchers subsequently suggested several ways that providers can help improve OC adherence: (4)

* Help each woman consider her contraceptive choices according to her individual needs and concerns.

* Stress the importance of a daily routine for pill taking.

* Emphasize that most OC side effects--especially spotting and bleeding--are transient.

* Dispel OC misinformation, and discuss noncontraceptive health benefits of OCs.

* Demonstrate correct use of the specific OC prescribed.

* Provide easy-to-understand oral and written instructions about proper OC use and what to do in case pills are missed. (See figure, page 18.)

* Suggest a backup contraceptive method (and provide a few condoms).

* Tell clients how to obtain more information about OCs and their use, in case problems or questions arise.

* Follow clients for signs of lack of adherence to pill-taking regimens. For example, telephone calls or visits from clients about spotting should alert providers to inconsistent OC use and may be an opportunity to review pill-taking instructions.

REFERENCES

(1.) Rosenberg MJ, Waugh MS, Long S. Unintended pregnancies and use, misuse and discontinuation of oral contraceptives. J Reprod Med 1995;40(5):355-60.

(2.) Rosenberg MJ, Waugh MS, Meehan TE. Use and misuse of oral contraceptives: risk indicators for poor pill taking and discontinuation. Contraception 1995;51(5):283-88.

(3.) Rosenberg MJ, Waugh MS, Burnhill MS. Compliance, counseling and satisfaction with oral contraceptives: a prospective evaluation. Fam Plann Perspect 1998;30(2):89-92.

(4.) Rosenberg M, Waugh MS. Causes and consequences of oral contraceptive noncompliance. Am J Obstet Gynecol1999;180(2 Pt 2):276-79.