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Hum. Reprod. Advance Access originally published online on August 24, 2006
Human Reproduction 2006 21(12):3137-3145; doi:10.1093/humrep/del290
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Evaluating information on oral contraceptive use: a randomized controlled trial to assess missed pill instructions

D. Chin-Quee1, E. Wong* and C. Cuthbertson

Family Health International, Durham, NC, USA

1 To whom correspondence should be addressed at: Family Health International, 2224 E NC HWY 54, Durham, NC 27713, USA. E-mail: dchin-quee{at}fhi.org

* The author is no longer with Family Health International but was lead biostatistician during data collection and analyses.

BACKGROUND: Instructions for what women should do when they miss oral contraceptive pills are complex and vary according to the quantity and the timing of missed pills. METHODS: A randomized controlled trial was conducted to assess the comprehensibility of four types of instructions rendered in both 21- and 28-day versions, as well as in graphic and text formats. Interviews were conducted with 864 current and past pill users in Kingston, Jamaica. Each was provided with scenarios of missed pills and one version of the instructions; they were then asked what they should do to avoid pregnancy. RESULTS: More than 60% of respondents knew what to do when one pill was missed, but most did not give correct answers for missing two or more pills in a row, regardless of the instruction type. CONCLUSION: Women generally do a poor job of identifying steps to take when multiple pills are missed. Graphic instructions are easier to understand than text-only instructions and less information is better. Findings suggest that rendering missed pill instructions in graphic format while scaling back on the breadth of medical information results in better comprehension.

Key words: contraceptive usage/health education/oral contraceptives/printed media/randomized controlled trial


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