Background
Health communication and interpersonal skills are increasingly emphasized in the measurement
of health care quality, yet there is limited research on the association of interpersonal
care with health outcomes. As approximately 50% of pregnancies in the United States
are unintended, whether interpersonal communication influences contraceptive use is
of public health importance.
Objective
The aim of this study was to determine whether the quality of interpersonal care during
contraceptive counseling is associated with contraceptive use over time.
Study Design
The Patient–Provider Communication about Contraception study is a prospective cohort
study of 348 English-speaking women seen for contraceptive care, conducted between
2009 and 2012 in the San Francisco Bay Area. Quality of communication was assessed
using a patient-reported interpersonal quality in family planning care measure based
on the dimensions of patient-centered care. In addition, the clinical visit was audio
recorded and its content coded according to the validated Four Habits Coding Scheme
to assess interpersonal communication behaviors of clinicians. The outcome measures
were 6-month continuation of the selected contraceptive method and use of a highly
or moderately effective method at 6 months. Results were analyzed using mixed effect
logistic regression models controlling for patient demographics, the clinic and the
provider at which the visit occurred, and the method selected.
Results
Patient participants had a mean age of 26.8 years (SD 6.9 years); 46% were white,
26% Latina, and 28% black. Almost two-thirds of participants had an income of <200%
of the Federal Poverty Level. Most of the women (73%) were making visits to a provider
whom they had not seen before. Of the patient participants, 41% were still using their
chosen contraceptive method at 6-month follow-up. Patients who reported high interpersonal
quality of family planning care were more likely to maintain use of their chosen contraceptive
method (adjusted odds ratio [aOR], 1.8; 95% CI, 1.1–3.0) and to be using a highly
or moderately effective method at 6 months (aOR, 2.0; 95% CI, 1.2–3.5). In addition,
2 of the Four Habits were associated with contraceptive continuation; “invests in
the beginning” (aOR, 2.3; 95% CI, 1.2–4.3) and “elicits the patient’s perspective”
(aOR, 1.8; 95% CI, 1.0–3.2).
Conclusion
Our study provides evidence that the quality of interpersonal care, measured using
both patient report and observation of provider behaviors, influences contraceptive
use. These results provide support for ongoing attention to interpersonal communication
as an important aspect of health care quality. The associations of establishing rapport
and eliciting the patient perspective with contraceptive continuation are suggestive
of areas of focus for provider communication skills training for contraceptive care.
Key words
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Article Info
Publication History
Published online: January 28, 2016
Accepted:
January 21,
2016
Received in revised form:
January 9,
2016
Received:
September 24,
2015
Footnotes
The authors report no conflicts of interest.
This project was supported by the Society of Family Planning and by grant K23HD067197 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) . Drs Schmittdiel and Schillinger received support from the Health Delivery Systems Center for Diabetes Translational Research ( P30 DK092924 ), and Drs. Dehlendorf and Schillinger were supported by National Institute on Minority Health and Health Disparities of the National Institutes of Health (NIH) under award number P60MD006902. The content is the responsibility solely of the authors and does not necessarily represent the official views of the NICHD or the National Institutes of Health. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; or decision to submit the manuscript for publication. The contributions of these individuals were supported by funding from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD) and institutional funds (P30DK092924 (to Dr Schillinger) and P60MD006902 (to Drs Schillinger and Dehlendorf.
Cite this article as: Dehlendorf C, Henderson JT, Vittinghoff E, et al. Association of the quality of interpersonal care during family planning counseling with contraceptive use. Am J Obstet Gynecol 2016;215:78.e1-9.
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