Can the preference for and uptake of long-acting reversible contraception in young Australian women be increased using an online “LARC first” educational video?

Problem

Unintended pregnancies have long been identified as a significant public health problem both in Australia and globally. Long-Acting Reversible Contraceptives (LARCs) have the potential to reduce rates of unintended pregnancy and abortion, particularly in young women, however the uptake of LARCs amongst Australian women is low. One of the barriers to LARC uptake is the lack of awareness of LARCs as a contraceptive option for young women. The internet and social media are increasingly being used by patients as a resource for health information, in particular, amongst young people. We aimed to determine if our online “LARC first” educational video can increase the preference for and uptake of LARCs amongst young women.

Approach

Australian women aged 16-25 years were recruited via a paid Facebook advertisement. The intervention involved viewing a “LARC first” patient education video developed as part of the National Health and Medical Research Council funded Australian Contraceptive ChOice pRoject (ACCORd). Participants completed online surveys before (Survey 1) and immediately after (Survey 2) watching the video, and six months later (Survey 3). The contraceptive preferences of participants was measured at each time point and their contraceptive use was measured in Surveys 1 and 3. Logistic regression with generalised estimating equations was used to examine the outcome of the intervention on preference and uptake of LARCs.

Findings

A total of 437 eligible women were recruited in December 2017. Of those, 322 completed Surveys 1 and 2, and 284 (88%) completed Survey 3 at six months follow-up. There was an increase in the preference for LARCs immediately after viewing the video (OR=1.73, 95% CI 1.44-2.09) and at six months follow-up (OR=1.35, 95% CI 1.11-1.64). Multivariate analysis showed that women aged 22-25 years preferred LARC more than women aged 16-21 years (OR=1.68, 95% CI 1.10-2.56).There was also an increase in LARC use at six months follow-up (OR=1.28, 95% CI 1.11-1.48). Multivariate analysis showed that women aged 22-25 years were more likely to use LARC compared with women aged 16-21 years (OR=1.25, 95% CI 1.11-1.48).

Consequences

Our results demonstrate that an online “LARC first” patient education video can increase the preference for and use of LARCs in young women for up to six months after viewing. This was more pronounced in those women aged 22-25 years. General practitioners could consider integrating these educational videos in consultations for contraceptive counselling. Further research is required to understand why this intervention appeared to be less effective in teenagers and young adult women.