Agreement between patient-reported and provider-reported choice of contraceptive method among family planning patients in New York City: implications for public health

International Journal of Women's Health, Aug 2013

Agreement between patient-reported and provider-reported choice of contraceptive method among family planning patients in New York City: implications for public health Alicia Ventura, Samantha Garbers, Allison Meserve, Mary Ann ChiassonResearch and Evaluation Unit, Public Health Solutions, New York, NY, USAAbstract: National data on choice of contraceptive method and subsequent use are critical for monitoring progress toward meeting public health goals in reducing unintended pregnancy in the US. Yet few studies have focused on the reliability of clinically-reported or patient-reported measures of choice of contraceptive method for the range of available contraceptive methods. Among 1,844 women receiving reproductive health care at two federally funded centers in New York City, choice of contraceptive method at the end of the visit from two data sources was compared, ie, patient self-report, and provider-report as recorded in the clinical-administrative database. Agreement between the two data sources was assessed for the sample. Sociodemographic predictors of agreement were assessed using logistic regression. Agreement between the data sources was also assessed on a method-by-method basis using positive specific agreement. Participants were predominantly Latina (69%), foreign-born (76%), and low-income (99% with incomes <200% federal poverty level). Agreement of patient-reported and provider-reported contraceptive choice was highest for hormonal methods (positive specific agreement 94.0%) and intrauterine devices (89.9%), and lowest for condoms (53.5%). In the logistic regression model, agreement was lower among teens aged 16–19 years compared with women aged 25+ years (odds ratio 0.74; 95% confidence interval 0.55–0.99). Because teens are more likely to rely on condoms, the logistic regression model was repeated, adjusting for provider report of condom choice; after adjustment, no sociodemographic differences in agreement were observed. National data sources or studies relying on provider-reported method choice to derive estimates of contraceptive prevalence may overestimate choice of condoms. Our findings raise the question of whether condom choice can be accurately assessed by a single open-ended measure of choice of contraceptive method.Keywords: contraception, condoms, methodology, service providers

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Agreement between patient-reported and provider-reported choice of contraceptive method among family planning patients in New York City: implications for public health

International Journal of Women's Health agreement between patient-reported and provider-reported choice of contraceptive method among family planning patients in new York city: implications for public health National data on choice of contraceptive method and subsequent use are critical for monitoring progress toward meeting public health goals in reducing unintended pregnancy in the US. Yet few studies have focused on the reliability of clinically-reported or patient-reported measures of choice of contraceptive method for the range of available contraceptive methods. Among 1,844 women receiving reproductive health care at two federally funded centers in New York City, choice of contraceptive method at the end of the visit from two data sources was compared, ie, patient self-report, and provider-report as recorded in the clinical-administrative database. Agreement between the two data sources was assessed for the sample. Sociodemographic predictors of agreement were assessed using logistic regression. Agreement between the data sources was also assessed on a method-by-method basis using positive specific agreement. Participants were predominantly Latina (69%), foreign-born (76%), and low-income (99% with incomes ,200% federal poverty level). Agreement of patient-reported and provider-reported contraceptive choice was highest for hormonal methods (positive specific agreement 94.0%) and intrauterine devices (89.9%), and lowest for condoms (53.5%). In the logistic regression model, agreement was lower among teens aged 16-19 years compared with women aged 25+ years (odds ratio 0.74; 95% confidence interval 0.55-0.99). Because teens are more likely to rely on condoms, the logistic regression model was repeated, adjusting for provider report of condom choice; after adjustment, no sociodemographic differences in agreement were observed. National data sources or studies relying on provider-reported method choice to derive estimates of contraceptive prevalence may overestimate choice of condoms. Our findings raise the question of whether condom choice can be accurately assessed by a single open-ended measure of choice of contraceptive method. r esearch and evaluation Unit; Public Health solutions; n ew York; n Y; Usa - use, with young women, women of low socioeconomic status, and black women (compared with women of other races) being found to be less likely to use contraception or more likely to rely on less effective methods, such as condoms.5,10,13–16 Consistent use of effective contraceptive methods prevents unintended pregnancy; this ongoing behavior requires l-u0182 canonitnrdaicveipdtuiavle tomefitrhsotdms.a1k7–e20aNcahtoi oicnealamdaotnagotnhechavoaicileabolef -J13 contraceptive method and its subsequent use, such as those on reported in the National Survey of Family Growth, are criti.207 cal to understanding the scope of unintended pregnancy as .946 a public health issue, to estimating numbers of women at .735 risk of unintended pregnancy, and to monitoring progress /ybom tporweganrdanmcye.e16t,i2n1–g25pNubaltiiconhaelaldtahtagooanlscihnoriecdeuocfincgounntriancteepntdivede .scse method, as reported in clinical-administrative records, are rpe also used to monitor and guide decisions about the allocation .vdow l.y of funding for publicly supported family planning programs, /ww oen such as the federal Title X program, which served 5.2 million / :s s women in the US in 2010.26 ttph luna In spite of the clinical and public health implications, few from rsoe studies have focused on the reliability or validity of either deda ropF clinically-reported or patient-reported measures of choice lon of contraceptive method for the range of available methods. odw A recent review of the literature concluded that information ltha on the validity or reliability of self-reported measures of oral seH contraceptive choice or use was scarce.27 To address this gap, 'ne this study assessed agreement between patient-reported and omW provider-reported choice of contraceptive method at famlfo ily planning clinic visits. Due to lack of a “gold standard” raun necessary to assess the validity of either patient-reported or lJoa provider-reported choice of contraceptive method, the aim of itno this study was to assess agreement, as a form of reliability, traen between the two sources of report. n I Materials and methods study design and setting The data used for this study were collected as part of ongoing quality assurance activities within a randomized controlled trial of a contraceptive assessment module at two clinics in New York City receiving Title X federal family planning funding (as reported elsewhere).28 All patient recruitment activities were carried out by two trained bilingual (Spanish/ English) project assistants between April 2008 and August 2010. Participants were recruited at time of visit and screened for eligibility. English-speaking or Spanish-speaking women age 16 years and over who had a family planning visit (...truncated)


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Alicia Ventura, Samantha Garbers, Allison Meserve, Mary Ann Chiasson. Agreement between patient-reported and provider-reported choice of contraceptive method among family planning patients in New York City: implications for public health, International Journal of Women's Health, 2013, pp. 533-540, DOI: 10.2147/IJWH.S49479